You would probably think that having done this over so many years and for so many times that it would have become second nature for me. Counting my first visit to Tanzania in 2009, I have now completed my thirteenth year of this long haul travel, through Amsterdam for the first years and now through Doha, Qatar, once they began flying into Philadelphia making the trip more palatable by allowing us to avoid either Newark or JFK and the extra travel involved getting there. Other than the craziness of March 2020, when the pandemic first took hold of the entire world, I’ve managed to completely miss NYC on these routes, and that includes the time I flew back the same day Hurricane Sandy came ashore and everything on the East Coast was locked up tight. Thankfully, they had me booked through Detroit (go figure how that could ever possibly be considered a blessing) and, after getting online to rent a car from the tarmac in Dar es Salaam, I drove through the night all the way home from Detroit just as Sandy made landfall and then laughed in my face all the way across Pennsylvania. Harrowing was an understatement, but probably no more so than those poor toll takers on the turnpike who were still in their booths to take my money.
So now, after making this trek to Tanzania 26 times and for well over half a million miles total, the truth is that it never gets old for me. Each trip is so very different from the team that is traveling with me to the changes that have occurred in my own life. In the beginning, I came on my own with little in the way of preconceived notions of what this be like, and certainly no idea whatsoever of what it was to become. There are no guides on how to do this, nor could I write one now even if I tried. I am asked repeatedly, by both novices and experts in global health, about how you can build a similar program elsewhere, but is next to impossible for me describe just how this all happened, other than to say it just did. The truth of the matter is that it just happened and, other than perhaps my being the common denominator, it has occurred because of the dozens of wonderful people and programs that have supported it, believed in it, and participated in it. What began as my traveling over to Tanzania on my own to see how I could help has now become a full-fledged neurology program caring for over 800 patients a year, training dozens of residents about global health over the last decade and, most importantly, improving the lives of so many patients suffering with neurologic disease, most treatable though some not, but at least bringing a level of understanding to a place where there had been none before. A legacy of enlightenment is something to be proud of and something that every single person who has been to FAME or followed our story should also share in the glow of success.
But for all that has been accomplished with the neurology program and all of the hard work that has been put in by so many, none of this would have been humanly possible had it not been for the presence of FAME and all those individuals who have continued to work tirelessly and every day of the year to bring state of the art healthcare to a region of Africa where there had been little before. When FAME first opened its doors in 2008 to see those very first patients, it was an experiment in global health. Having the foresight that a non-profit, NGO could be created that would employ only Tanzanian caregivers and workers and function seamlessly with only the peripheral assistance of Western volunteers was a stroke of genius and I am sure something that could never have been imagined would become the premier health facility (and now a hospital) in Tanzania. Had FAME not existed when I had traveled to Tanzania in 2009, had we not asked to do some volunteering and had I not asked our safari guide, Leonard (now part of my extended family) to take me to a Tanzanian medical facility, none of this would have even had a chance to come to fruition. Making such a life change was certainly not something on my radar at the time, and had you told me that I’d be spending several months each year in Africa for the remainder of my career, I would have thought you mad for the mere mention of such a preposterous scenario would have ludicrous. But yet, here I sit in the Doha airport, now having spent well over a total of two years of my life in East Africa, a place I had dreamed and read about as a child while following the careers of such individuals as Louis Leakey, Diane Fossey, and Jane Goodall. How could one have ever predicted this?
But it is not only FAME that has been essential in the creation of our neurology program as a huge amount of credit has to go to our partner institutions, the University of Pennsylvania and Children’s Hospital of Philadelphia, both of who were instrumental in their support both in the funding necessary to bring our residents over there, but also in the recognition of just how significant it has been for our residents to have the opportunity to experience practicing in a low resource, limited access region where there are no specialists and merely seeing a doctor, let alone a neurologist, can be an undertaking of epic proportion. Bringing residents, fellows and other neurology faculty to FAME has not only enabled us to see that many more patients alongside the Tanzanian caregivers, thus capacity building, but it has also created the ideal environment for continually providing educational opportunities that travel in both directions. In the past, with the assistance of Penn’s Center for Global Health and the Perelman School of Medicine at Penn, we have sponsored a medical student to come on rotation for a month, an event that was not only life-changing for the student, but also provided an incredible perspective for those in Philadelphia who were so fortunate to have worked with him. This last May, were also able to provide the very same experience one of the doctors at FAME, Dr. Anne, someone who I have now worked with for over a decade and the one most responsible for providing neurologic services to patients at FAME in our absence.
The success of our program can certainly be measured in the number of patients we’ve seen over the last dozen years and the number of patient’s lives we’ve changed along the way, but that success is also reflected in the number residents who have traveled to FAME over this last decade and whose careers have been affected in an incredibly positive manner. Whether they make career decisions such as mine, choosing to devote a major portion of their time and energy to treating those patients in underserved and resource limited settings, or whether they take what they have learned and seen and apply it to their career paths going forward, the world will be a better place without question. What started as a one off opportunity in 2013 and proved itself so incredibly successful, soon became a major operation involving two month-long trips per year, each with four residents and often a medical student. As residents interested in pursuing a career in global health or those interested in participating in such an experience began to apply and match more frequently, we soon found that the volume of residents wishing to come to FAME outstretched our capacity to accommodate them given the restraints of 8 residents per year.
As such, this will be the first trip to FAME in which I will have two groups of residents, each coming for three solid weeks of patient care and education and swapping out midway through my six weeks at FAME. What had previously been one month in Tanzania for me twice a year has now become six weeks twice a year, and when you take on some extra time to spend at Muhimbili University in Dar es Salaam to work with their neurology fellows, I will have spent seven weeks this trip and very likely seven weeks for the next trip. I have three adult neurology and one pediatric neurology resident arriving with me and they will swap out with a group of three adult neurology residents in three weeks. I will still do my very best to make this not only a medical experience, but also a cultural one as they will work and eat on a daily basis with the Tanzanians, and other than our brief trips to the game parks and perhaps a dinner or two at one of the safari lodges, they will spend their time with the FAME staff and learn, at least in some small fashion, about the people of East Africa and Tanzania, perhaps one of the most diverse of all African countries with over 120 culturally diverse tribes and nearly as many languages. A country of incredibly colorful and lovely people who will open their door to anyone in need and demonstrate an unmatched resiliency in their lives. It is a country and people I have come to love and the fact that I have been able to share this with others has been a blessing beyond anything imaginable. Combining the things that I love most in this world – equity, diversity, neurology, education, and patient care – has been a dream come true.
Over the next six weeks, I will hope to provide a window into this experience and share some of the adventures, and at times, misadventures, that we will all make together. Africa is a continent so vastly different than most of what we have known for our entire lives, yet we will soon be there, traveling through these huge expenses of sparsely populated regions where the wild animals almost always outnumber the residents. Enjoy of my blog what you wish and for those of you with loved ones here, you will hopefully have a glimpse into their day and will certainly hear many stories later, I am sure.