We have been seeing a record number of patients in our neurology clinic, far outpacing even the busiest of the pre-pandemic clinics. There had always been a difference between our two clinics with the greatest number of patients always being seen in the fall months, a situation that had always been thought to be due to the planting season in March keeping people from clinic, though it was never something that we knew for sure. From day 1 of this trip, though, we have been steadily inundated with patients suffering from all sorts of neurologic diagnoses and that has included the mobile clinics. Having taken yesterday off to go to Manyara so that Whitley and Meredith would get their second game drive in, we were now going to be in clinic all day, and even though last Saturday had been very busy, today wasn’t looking quite the same.

With Whitley and Meredith having plans to depart this morning as their flight out of Kilimanjaro was scheduled for 5pm, there was no intention of having them work today meaning that I was now on my own staffing the four resident teams that we had been using so far. Not that I hadn’t done this in the past, but I had definitely gotten used to the luxury of having two fellow attendings available to staff patients with me. They had both decided to have a nice breakfast at the Lilac Café, our onsite cantina that had been built when the hospital came into being as there needed to be a kitchen to prepare food for the patients and a restaurant where visiting family could find food as many would stay in the area having often come from distant locations.

Sitting outside of Lilac for breakfast, or even a simple coffee, has to be one of life’s true pleasures for there is absolutely no sense of time and all of your troubles seems to melt away in the breezy sunshine that is ever present. The menu here has both Western selections for the volunteers and the stray tourists that end up there as well as local selections for the visiting families that may be staying in the area. Since it’s conception, Lilac has always been a staple here for the volunteers for either the weekend dinners that are not supplied by FAME or if one develops a hankering for food more familiar to them during the week. If you happen to miss breakfast at home, you can always catch a coffee or a samosa there to bring to clinic. Thankfully, though, lunch for the entire FAME staff is served every day of the week.

Given the short clinic today that ended by around 3pm, we took the opportunity for a group walk through the nearby fields so I could finally show everyone the loop that we have used over the years that is around 3 miles and takes 45 minutes to complete. Since the very beginning, long walks or runs have been the best source of exercise while volunteering here at FAME. As some may recall, though, I did buy a mountain bike for my visit back in September 2020 during the pandemic when I was here all alone as travel had been banned for the medical students and residents. Biking here was a blast, but required sufficient time in the afternoon/evening and is difficult to do given our current schedule. Besides, I choose not to abandon the residents in the evenings as these are some of the best times we have to share our stories of the day and life here.

On my very first visit to volunteer at FAME, I had decided to hike to a distant ridge, which I now know is within the Shangri La coffee plantation, to take some photos of the wonderful sunset we see every night here. I had told my two roommates, Carolyn and Joyce, where I was going and promptly set off on my expedition to reach that distant ridge I had my eye on. Unfortunately, I hadn’t planned very well at all, bringing only my camera and small backpack without a flashlight or phone, the latter of which wasn’t really a thing here back then. I reached the ridge after a good hour’s journey and managed to get a few, mostly disappointing, mediocre shots of sunset that didn’t do it justice and turned back for my return trip in the quickly fading light that is so typical here. When sunset happens near the equator, it is very much like a heavy, dark curtain suddenly falling and there is no dusk. In the quickly spreading blackness of the night, and without a moon to light my way I should mention, I suddenly realized the error of my ways and the fact that I had no means of illuminating my path home that would lead me through not only the coffee orchards, but also through some very sketchy, overgrown and dilapidated orchards I had walked through on my way up and had remembered being a bit weary and that was in the light.

To this day, I don’t recall most of that walk, during which time I had to suppress every fear my mind managed to drum up along the way, from leopards to cape buffalo, with every shadow and every bush looking like a wild animal. The walk back to FAME seemed like it lasted forever and when I finally returned and walked through the door of the volunteer house, Carolyn and Joyce were both incredibly relieved to see me, but equally furious with me for putting them through having thought that I had been eaten along the way. They both admitted that they had been very close to sending out a search party, but given the early days of FAME, were unsure of who to have contacted to arrange that. I learned many lessons from that experience that included not only hiking where I had no I idea where I was going or how far it was, but also never putting a roommate through such an ordeal. And yes, I travel nowhere without a torch, or flashlight, these days.

Our power walk this day served its purpose of getting everyone’s juices flowing well. The others had undertaken a few runs over the last weeks, though I had wanted to show them the loop we have used over the years and there was little question that I could use the exercise in the process. The fields next door to FAME in the direction of our walks are gorgeous and there are trails the locals take through them to get to their work or to school, though depending on when the fields were last plowed or when it last rained, the trails can be less than easy to follow or incredibly muddy to where your feet suddenly feel like they each weigh 10 lbs. after completely caking with the dense red clay. Thankfully, we were reasonable able to follow the path this afternoon as it coursed along the edge of the recently plowed field near the line of trees that separates one field from the next. When exactly to break away from the path is the tough part as otherwise you will end up in circles. We found the larger road to take next and then looped up along the top of the fields for the return trip home. The route is not entirely obvious to the uninitiated and my hope was that the others would remember the turns to take, but that isn’t always the case.

We returned home in plenty of time for some rest and showers prior to all of us meeting for dinner at Happy Days, one of the local pubs here in Karatu, that had been arranged for a number of FAME who had been on a hike to the crater rim earlier in the day. Though Happy Day had been the ex-pat hangout for many years, there had been a number of management changes and I hadn’t been there in several years. It’s hard to judge whether the food served tonight would be representative or the same as just sopping there for dinner, but tonight’s meal was incredibly delicious – rice and beef stew, roasted chicken, coleslaw and salad. Everyone had a wonderful time at dinner and the foosball table served to bring out the killer instinct in even the meekest of my residents. I believe Natalie and Savannah may have been the most serious, but sweet Alex was definitely the sleeper of the group, winning several games quietly and inconspicuously. As for me, a single game played quite sloppily was enough to tell me that foosball would not be my road to retirement and that I should stick to being an observer and simply cheering on the others.

We had planned to finish the night at the Golden Sparrow as everyone was once again looking forward to the dance floor there. We loaded Turtle and made our way over to the Sparrow, taking back roads as it was only about a kilometer as the crow flied and our route was not much more than that. The club was pretty much empty other than us, with perhaps a local couple or two sitting in the shadows and the normally present DJ hadn’t arrived yet. Of course, that didn’t stop any of us from hitting the dancefloor and we were off to the races with essentially three hours of non-stop dancing. The best part, though, was that the club began to completely fill up with a whole array of locals, some of who also took to the dancefloor, joining us, and it was a super special time as even though we were visitors to this lovely country, there was clearly a greater sense of oneness that night.

The well-known phrase that we often use in the US has been modified here, though still fully applies. “What happens at the Sparrow, stays at the Sparrow.” I do know that many of the past residents and faculty who have accompanied me in the past very much appreciate this fact and it has been my duty to make sure that everyone returns safely after a night at the Sparrow.