Wednesday, March 16 – A visit to Rift Valley Children’s Village…

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Eliza, Dr. Anne, and Natalie sharing the pediatric room

Rift Valley Children’s Village, or RVCV for short, is a very special place for so many reasons, though one of the most important for me is its connection with FAME. When Frank and Susan had made the decision to come to Tanzania and set up a health clinic, the exact location and nature of the clinic had not yet been decided. In the end, though, it was through their meeting and connection with India Howell, the founder of RVCV and its parent organization, the Tanzania Children’s Foundation, that was to be the guiding light and the determining factor when it came to FAME’s location and, in the end, its proximity to RVCV and Ngorongoro Crater. To be honest, I don’t know the full story behind how the location of RVCV came to be, but it preceded FAME by several years.

Peter and Daniel seeing a patient together. Daniel is now a clinical officer and one of India’s children

Rift Valley Children’s Village came to be when India, who had come to Tanzania with the tourist industry, quickly became aware of the vast number of “street children” here who were essentially homeless as they were either orphaned or their parents were no longer able to care for them. Rather than creating an orphanage, where the children would still lack a true home, she partnered with her Tanzanian business associate, Peter Mmassy, to create both the Tanzanian Children’s Fund and RVCV, the latter serving as a true home for the children living there who would all be adopted by India and Peter, growing up in the village with their family and eventually going away to college and making a life of their own. Over the last several years, the number of children has remained stable at around 100 and their ages have ranged from infancy through early adulthood.

Nuruana and Alex evaluating a patient

India and Peter also had the insight very early on that their children would need the best of medical care that could be provided in Tanzania and this is how the relationship with FAME came to be. Locating FAME in Karatu would not only allow for the much needed care of patients throughout the Karatu district and the NCA, but its location would also allow an opportunity for those tourists traveling through the area to give back to the communities they so enjoyed during their game drives here. Over the years, as FAME has continued to grow, the relationship between the two organizations has continued to solidify.

Savannah and Africanus

Something that India also realized very early on was not only the need for her to provide basic medical services for her children, but also for the surrounding community for the children from these villages would all be in the same school with her children and all going home to their families for the evening. Without having a healthier population in which the children of RVCV lived and played, it would be difficult to keep her children healthy. Thus, began the collaborative effort of RVCV and FAME in providing not only the clinics to administer the medical care, but also the funding to cover the cost of that care as the region surrounding RVCV is extremely poor with the only real means of support  picking the coffee beans during the very short harvest window. FAME doctors and nurses would travel to the Children’s Village two monthly for these clinics and, in the early years, neurology would tag along with the FAME crew and run a clinic side by side with the general medical clinic.

Lunch with the RVCV volunteers

For a number of reasons, the general medical clinics at RVCV ended as it was felt to be more efficient to have some of the care provided by a full-time nurse or clinical officer onsite and any patients needing further care could travel the short distance to Karatu and be seen at FAME as there are cares traveling back and forth all day long. The neurology clinics continued, though, and became part of our mobile clinic week where our team would travel to RVCV for two consecutive days in which we’d see all of their children and also provide continuity care to the neurology patients from the community. As such, it has remained one of the cornerstones of our neurological care here in the Ngorongoro Highlands and probably one of the favorite activities here for the residents as the Children’s Village is an absolute pleasure to visit not only for its facilities, but also for the incredibly uplifting sense of wellness one gets by just being there. If there truly is a Shangri La, this is surely one of the leading contenders.

Our lunch spread

The road to RVCV is entirely another story. In good weather, it is a bumpy and dusty trail that traverses several ridgelines and drops into an equal number of ravines along the way. Portions of the road are quite steep, necessitating the use of one’s transfer case and the low range gears when driving a large, fully-loaded vehicle such as Turtle. The problem was that they had done some repairs on Turtle while I was in the US, one of which included replacing the gearbox, and they had apparently not checked that the transfer case shift lever had enough clearance with the lower portion of the dash. It’s a bit of a long story, but Turtle is actually a Td5 Land Rover, but the engine and gearbox had been replaced with older 300 series units due to their better reliability. Though more reliable, the fit isn’t exactly perfect, hence the issue with shift lever and the fact that I had no low gears, not a problem for the morning drive, but as you will soon see, was an issue for the return trip.

Alex (in the middle) staffing with Whitley (L) and Meredith (R)

The first time one arrives to the Children’s Village, it’s an experience. There is a sense of calmness that comes over you as you enter the gate and only continues throughout the day. Driving up to the administration building, our patients are immediately visible sitting on benches out front waiting to be registered. Africanus, who I had worked with previously, is now the clinical officer there after having working for a brief stint at FAME. He is the perfect person to be running the health center there for a number of reasons that include his personality and the ease with which he deals with any situation and has also organized our visits there. All the support staff are there, charts have been pulled and we have separate stacks of children and adults needing to be seen. Including his office, which he has always graciously given to us, there are four examination rooms all ready for our use along with a room for the pharmacy. In addition to the translators we bring, any of the older children there can also help out as their English is impeccable.

Dr. Anne and one of her patients

Natalie had the most appropriate of rooms in which to see her children as it was decorated as one would imagine a pediatrician’s office would be. She worked with Dr. Anne and they had a selection of patients that included epilepsy, headache, and learning disorders. The latter is always a challenge as the children don’t always come with collateral information from a parent or family member and most often we don’t have a teacher, just a report. Though RVCV does work with a psychologist, the visits are not on a regular basis and getting some more formal testing, such as neuro-psychological testing can be very difficult or impossible to obtain. Having the resources that we do in the US for these situations becomes eye-opening and trying to navigate the intricacies of educational accommodations here is typically an exercise in frustration.

Anne and Natalie seeing Valentine

One of the highlights of our visits to RVCV has to be the lunch that is provided for us that is served alongside all of the other volunteers there. The mamas that do the cooking are simply amazing and the lunches are an assortment of homemade items that typically includes freshly baked breads, incredibly fresh salads, and local fruits. Today’s lunch was a Tanzanian version of a burrito with thin chapati, hamburger meat, rice, fresh tomato salsa that we assembled ourselves and smothered in lots of hot sauce. Though I am constantly raving about the wonderful lunches at FAME (basically beans and rice with mchicha and pili pili sauce) that I miss terribly on my return home, I will have to admit that the lunches at RVCV are a fantastic diversion to the routine at FAME and, between the two of them, it is a wonderful balance.

Valentine’s incredibly infectious smile

One of the other highlights for me has been the opportunity to have cared for many of my patients over a number of years, and one such patient, Valentine, is a young boy who I have become particularly attached to over time. I began seeing him when he was very young and was having a great number of seizures as a result of his probable hypoxic-ischemic injury at birth and he also has a fairly profound spastic hemiparesis. His anti-seizure medication was changed and he has now been seizure-free for several years as a result. Though he remains significantly impaired from his birth injury, the fact that he has been seizure-free has allowed him to gain skills and the risk of SUDEP, or sudden unexplained death in epilepsy, has great decreased with the seizure control. In the past, he would always try to hide from me when I came in the room, usually under his mother’s arm, but would warm up to me as remained present. This time, he broke out into an enormously wonderful smile when he saw me and had no intention of hiding under his mothers arm, but rather was totally engaging from the moment I walked in. I realized that he was now growing up.

Valentine and me

One of the unforeseen issues of having senior residents come in the spring is the chance that it will conflict with their interviewing for fellowship programs. We have a similar issue with the March trip for medical students as it conflicts with Match Day, though I have never really understood how missing an incredible adventure to Tanzania could possibly be equated to being present for a single day in which you find out something that can’t be changed. This is often a day of celebration for most, as well as a disappointment for some, but in all honesty, the only reason to be present in the US would be if you didn’t happen to match at all and needed to scramble to find a last minute spot. That is a scenario that most would know well in advance or at least have some inkling of the likelihood. In any event, Alex had to be home by 5:30 pm tonight for a fellowship interview which was to begin at 10:30 am in the US and was to run for about 7 hours! She would be up until the wee hours doing her interview on Zoom interviews to which we have become accustomed.

Loading Turtle in the heavy rains

In the afternoon, though, it had begun to rain fairly steadily and continued raining for the remainder of our afternoon session. That was concerning as it now meant the road that we had taken in this morning would now become a muddy slip and slide and trying to navigate the steep downhill sections would be incredibly treacherous given the lack of low gears that I had discussed earlier. Descending these roads was challenging in the best of conditions and when briefly tapping your brakes to slow your downhill speed could mean the difference between maintaining control or starting to slide, having the engine slow your descent is essential. Additionally, the rear of the vehicle continually slides from side to side depending on the ruts in the roads and is quite exciting for those in the rear seats as they get to experience the greatest effect of this given the distance they’re traveling. Controlling your vehicle in these conditions is anything but easy and finally reaching the tarmac was met with a cheer as it meant the difference between digging ourselves out of a ditch and having Alex miss her interview versus enjoying dinner on time in our comfortable home. Thankfully, it was the former, and Alex made it to her interview with time to spare.

On the way home, I also saw Soja, our mechanic here in Karatu, walking along the road in front of his home/shop and was able to arrange bringing Turtle in at 7:00 am the following morning to look at the transfer case shift lever to see if he could fix it. We would be returning to RVCV tomorrow for another day of clinic and I was very concerned about our ability to even make it there given the condition of the road on our return this even and that didn’t account for the massive amount of rain we were about to receive overnight.

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