Having survived our day at the Barazani dispensary with a clinic full of patients, it was now time for us to make the long drive again, but to a different dispensary in a somewhat more remote area. Thankfully, the Mang’ola road has been in great condition and the typical dusty conditions have been less with the small rains that have come. Our drive is along the same route save for the very end where we head away from the lake to cross a huge ravine and bridge that has served as a backdrop for many a photo in the past. These routes have become second nature to me over the years, though I will have to admit that I’ve had a keen sense of direction since childhood having studied maps when others were reading books. Traveling once to a remote location is typically all that is required to imprint the route in my brain forever, often at the expense of more mundane, though equally important facts.

 

Regardless, we pulled into the dispensary at Mbuga Nyekundu to find a brand new building that we would be using instead of the previous wards. The new building was quite nice with a large central atrium and lots of fresh air, though the numerous rooms for us to choose from were completely lacking of furniture requiring that we raid the other buildings of any chair, desk or table we could find that would enable us to have four mostly outfitted examination rooms. It did take a bit of time to get everything situated, but once we did, patients were brought in for the residents to see with Whitley, Meredith and me staffing them as they went.

 

Once everyone was up and running seeing patients, Kitashu, Safari and I left to travel to the Barazani dispensary as we had to drop off medications for some patients who were told to come back today and we also wanted to complete our discussions with Dr. Damien. I drove and we took a shortcut that included driving across a huge dry riverbed with probably ten foot walls that must be incredibly impressive when the heavy rains come and it fills to the brim with raging water and would be totally impassable. I remember crossing one of these streams a number of years ago in the FAME bus when we were on the larger FAME mobile clinic. It was very late and sun had gone done, but we still a distance from clinic. The water was roaring down from the foothills and the drop off into the stream was far too large for even for our bus, which is an all-wheel drive vehicle and has very high ground clearance.

 

It took some effort from a number of team members using shovels and axes to break down the riverbanks in preparation for our entry and hopeful crossing as the water level began to drop. It took perhaps an hour or so for this to eventually happen, though not before an elderly Datoga man on a bicycle choose to ride across the river, looking at us with some consternation at the commotion we were making when we could have simply driven across.

 

Once back at the Barazani dispensary, we found the patients who needed the medications we had brought with us and again sat down with Dr. Damien to discuss what type of support we might be able to offer their clinic in the future. They have been so helpful to us by allowing us to come here and partner with them in providing the neurologic care that we do with their assistance. We eventually said our good byes and departed back to the dispensary at Mbuga Nyekundu where the rest of our team was diligently working to finish the patient load there. Shortly after, it was lunch time and we all gathered at the vehicles to again enjoy our lunch boxes from the Golden Sparrow that had more than enough food for each of us and I am sincerely doubtful that anyone of us was able to finish all of the food. We often eat in our vehicles or somewhere completely out of sight of the patients and their family members to be respectful of the fact that many of them may not have enough food to eat. When I had first gone to Kambi ya Simba many years ago and our team was so small, the village had prepared a traditional lunch for us. It was such a tremendous thrill for me at the time, to have been treated as such an honored guest out of their appreciation.

 

The most interesting patient of the day, though was a very young child who had weakness of one of her legs and severe scoliosis that was easily seen on an x-ray that had been done in the past and which the mother brought to us. The child appeared otherwise neurologically normal in regard to its development and the other limbs, but the x-ray was very abnormal and not something we as neurologists would normally read. Using our WhatsApp neurology consult group that includes many residents as well as a pediatric neurology attending at CHOP and a neurosurgeon, we sent an image of the film as well as an image of the child. Unfortunately, it was a very difficult case for those who were reviewing it and it was decided to have the images reviewed by radiology at CHOP. Obviously, the question, depending on what’s going on, will be whether there is anything we can do about it going forward. If that is not clear on the x-ray, then we can always obtain a CT scan at FAME.

 

Our clinic was not nearly as busy as it had been on Monday at Barazani and our plan for the afternoon had been to visit Lake Eyasi as we had done last fall. Lake Eyasi is one of a series of shallow, elongated lakes that can be seen throughout the Rift Valley of East Africa and also include Lake Manyara and Lake Natron. These lakes are highly alkaline though manage to maintain a good supply of small fish that apparently produce enough of an income for them to continue their longstanding tradition. We had gone to visit the lake last September and it was an awesome experience as not only was the scenery incredibly picturesque, but the fisherman were also wonderfully generous in offering to take everyone out in the little dories. Of course, this sounded like a fantastic idea, though it was not until the boat left with about half of our team that they realized a steady bailing of the boat was required to keep it afloat due some serious leakage. Despite this serious flaw in our planning, the afternoon had turned out to be one of the highlights of our trip.

 

So, with this prior adventure in mind and the hope of a similar experience, we had planned to depart from Mbuga Nyekundu with time enough to get to the lake and enjoy the sights in a similar fashion as last September. As we were packing up, of course, one additional patient came who sounded like they had migraines, and rather than having her travel all the way to FAME for a relatively simple problem, Alex offered to see her and, thankfully, it did turn out to be a simple issue. So often, we’ll offer to see an add-on patient at the end of clinic and find that they are the most complex patient we’ve seen all day. My mantra is, “no good deed goes unpunished,” but the seems to portend a rather pessimistic view of the world, one that I certainly do not have. An alternative, and perhaps more positive, explanation might be that in offering to help, one must always accept whatever comes along, whether it be complicated or not.

 

We were on our way at an earlier enough hour to head to the lake and took the shortcut to Barazani that we had taken earlier, thought the dry riverbed and then turning off the main drag in the direction of the lake. The route took us through areas that are not typically traveled by large vehicles and, at times, they were simply not wide enough leaving the vegetation slapping at the sides of our Land Rover with a sudden “thwack.” We eventually came upon the very same beach that we had visited last September and I’m sure that we were remembered by the fisherman as we pulled up onto the beach and parked the two vehicles. Everyone was excited to dip their feet in the water and it was a gorgeous day with the sun shining bright and the temperature not too hot. The small waves of this large, shallow lake were continuously slapping against the sandy shore in an almost mesmerizing rhythm.

 

Far out into the lake, the small dories of the fishermen plied, setting their long nets and then paddling back to shore to begin the process of hauling them in by hand. Each of the fishermen has his own harness made out of old burlaps sacks that he steps into, places it around his bottom, hooks into the line and then very slowly walks backwards as the net inches towards the shore. Multiple men will hook into the same line and as the first one has walked as far as he can on the beach, he unhooks from where he is and walks back to the water to hook back in and start anew. Given the weight of the catch and the length of the net and lines, this process will take quite a long time. I haven’t been there when one of the nets was completely brought ashore, so I can only imagine what the catch must be based on the resistance I felt when helping to pull the nets in.

 

Meanwhile, Kitashu once again spoke with the fishermen on our behalf to see if they would be willing to take a boatful of people out onto the lake for fun. About half of our group immediately volunteered to go on the first boat ride, including Eliza, who I don’t think knew what she was getting into initially. The boat had barely gotten out when it returned to drop her back off on sure as she became nervous. Now, I will have to admit that these boats were really not for the squeamish or risk adverse as it became immediately apparent upon launching that the boats required constant bailing to remain afloat. So, you might ask, why would anyone in their right mind get into a boat that is sinking even before the voyage begins. Though that is a very good question and I wondered the same thing last trip when I chose to remain on shore and take photos instead of getting into a boat, I don’t have any excuse this time as I was caught up in the excitement and jumped in the second boat without a thought.

 

With everyone onboard, we weighed anchor (not really, but it sounded good) and began to make our way to a little island that seemed so far away when looking from shore, but when we made it out there and then looked back, it was clear that we really hadn’t traveled very far at all. As we approached the sandbar, a lone flamingo and albatross were initially lurking around, but they quickly took their leave on our arrival not wishing to share their little piece of real estate with us. We spent some time exploring this tiny island, which took all of a minute, looking back at shore and realized that the other boat with the second half of our group had now decided to come out as well. Not wanting to disturb their experience, we chose to shove off head back to shore first. Like passing ships in the night, we each took the opportunity to photograph the other, while headed back to wait.

 

The visit to the beach was one of the highlights of our visit to the Mang’ola region, an incredibly remote corner of this wonderful part of Tanzania that we have all made our home, for some of us much longer than others, and we jumped in our vehicles for the trip back to Karatu. One the way, the other vehicle carrying our support staff chose to stop at one of the onion fields, their local crop here, to purchase a supply as the price was much better there than in town. Certainly not something that would happen in Philadelphia.