Given the shorter time for the rotation (three instead of our previous four weeks), it became essential to maximize the amount of time the residents spend at FAME. In the past, I would typically fly out several days in advance of the residents, which would give me to time to spend with the Temba family (My Tanzanian family), check out the Land Rover and generally get things in order for our upcoming visit to FAME. Then, I would drive to the airport to pick everyone up when they arrived. For this trip, it was essential that we all flew out of Philadelphia on Friday night as this would put us into Kilimanjaro International Airport on Sunday morning and allow us, after a brief traditional stop at the Temba’s for brunch (Pendo would absolutely kill me if we did not make time for this), of course, to arrive to FAME Sunday afternoon and be prepared for their orientation first thing Monday morning. It would be rock and roll time Monday afternoon when will begin seeing our first patients of the visit.

Likewise, it required some other modifications to our previous schedule that I had fine-tuned over a number of years, but in the end, it was more important for us to make sure that everyone who wanted to come could do so rather than imposing a selection process where there would inevitably be unhappy people, something I try to avoid like the plague. Previously, we had done at least four mobile clinic days for each rotation, but the amount of resources required to provide these services, though certainly worthwhile, does tax FAME quite a bit and any decisions that would affect the day to day operations of FAME, such as taking a nurse or clinical officer away from their normally appointed duties, can be problematic. As such, we’ve decided to keep the total of number of days the same for both spring and fall, four for each seasons, and have each group do two of these clinics Though the clinics are all very similar, the day at Rift Valley Children’s Village typically sees most children, so we have decided to do that one first while Cara is here as she is our pediatric neurologist on site.

Despite an eight hour layover in Doha, everyone seemed awake and ready to make the final leg of our journey onward to Tanzania. The flight to Kilimanjaro was expected to last just a bit over five hours and, having a planned departure time of 2:10 am, our internal clocks were seriously hurting at this point, our bodies probably having no idea of what the time zone we were in, though somehow managing to put one foot in front of the other to board the plane. The flight was quick though it was also completely booked with nary a seat remaining anywhere on the entire plane. It was certainly great to see that tourism had rebounded in the wake of the COVID pandemic, I only wish it had chosen another flight to have proven that this is indeed the case. Arrival at Kilimanjaro International Airport is always a bit hectic as having a wide body jet full of eager passengers descending on a tiny airport, all of who need to go through immigration is a real sight. Thankfully, the onsite testing for COVID, which had been done up until very recently, was discontinued and we didn’t to deal with that aspect, at least. Also, we had all purchased our visas online which was one less hurdle to jump through at the airport, though I had to double check that the immigration officers were stamping all of our passports as a business visa since that’s what the government requires of us to “volunteer” at FAME. Once through customs, which at times has been a bit of a hassle for us, we emerged into the bright sunlight and were finally in here in Tanzania. I can still recall my first trip in 2009, with Daniel and Anna, as we stepped out of the terminal looking among what seemed like an ocean of safari guides each holding a sign signifying their company and the clients they were searching for. Little did I know that what was to be an amazing adventure with my two children would truly turn into a life-changing event as here I am, now thirteen years later, still returning to the same small airport, though now with a much different perspective and an entirely different mission at hand.

Suleman, a friend and business associate of Leonard’s, was picking us up at the airport today and thankfully he recognized me for there was no way I would have picked him out of the crowd had he not. We had gotten through immigration and customs rather quickly and there still remained a great many of the arriving passengers back in the terminal awaiting their turn to go the tedious process that we had just completed. With all our luggage, we schlepped across the parking lot with its sea of safari vehicle in every color imaginable until we finally found my trusty Turtle, a green 2009 converted stretch Land Rover Defender that has taken me everywhere and back again throughout this amazing country. We once again played Tetris, our game managing to fit nearly all of the larger bags in Turtle’s boot, making sure to leave enough room for the passengers so as to prevent anyone from having to ride on the roof Mitt Romney style. I will have to admit that the drive back to Arusha was incredibly painful not only for the incredibly slow trucks on the road, but also for Suleman’s slow driving as it took well over twice the normal 45 minute drive to get  to Arusha to make our date with Pendo’s breakfast plans.

Leonard and Pendo are my Tanzanian family and, had it not been for their incredible support along the way, it is quite likely that none of what exists today as far as our neurology work here in Tanzania would have ever occurred. Prior to the pandemic, the flights through Qatar, which included a 16 hour layover in Doha principally so travelers would leave the airport and spend time (and money) exploring the city, would have us landing in the afternoon necessitating that we spent the night in Arusha as driving here after dark is terribly dangerous. Leonard and Pendo would have our entire group spend the night at their home along with feeding us and, despite my constant protestations, would never allow us to reimburse them for any of the costs. For the residents, the experience was wonderful as they spent their first night in Tanzania in a home rather than a hotel, learning first hand and quite early about the fantastic hospitality and warmth that exists here. With the pandemic, travelers were no longer able to leave the airport, layovers were shortened, and our arrival time to Arusha was changed to the morning allowing our travel to FAME in the same day. Still, Pendo would not hear of having us arrive without a visit, so she prepares an exquisite breakfast spread for everyone, still refusing to accept anything in repayment for, as she always reminds me, I am family and we are guests to their country here to help.

Completely replenished now of all dour nutritional requirements and then some, it was time for our departure and to begin our journey to FAME, some two plus hours away in the Ngorongoro Highlands and across the Great Rift Valley that transects this part of East Africa and is well-known as the cradle of mankind. Suleman needed a ride into town after having driven us from the airport which meant that we wouldn’t be taking the bypass and would rather head through the traffic of town though since it was a Sunday, it wouldn’t be as bad as a weekday. To be honest, though, I have missed driving through town since the bypass was built as Arusha is a an incredibly colorful and bustling city that has become one of the site of population here in the East African Community and has been slotted for its capitol. Driving through town, though, did afford us with the opportunity to visit the Shanga Shop, a delightful little gift shop that is now at the Arusha Coffee Lodge, and has been around forever. It began as an organization that hired those with disabilities to create and produce works of art from recycled glass that includes glass blowing and jewelry among other things. They also now make many items with fabric in addition to the glass objects and it is all incredibly beautiful.

Leaving the Arusha Coffee Lodge, we were essentially out of town and heading west along the main and only highway traveling in the direction of Karatu, FAME, and the Serengeti. Driving here can be a bit of a challenge and that isn’t considering the right-hand drive that I had adapted too long ago. It is more so because of the trucks and buses that ply the highways at high speed in complete defiance of the police, the herds of domestic animals that are often crossing the road in route to their next watering hole or patch of grass, and the roads in general that can be in various states of disrepair as you travel along. Making our way to the Great Rift Valley with its immense Lake Manyara, famous for the site of Hemmingway’s non-fiction novel, The Green Hills of Africa, that documents his hunting of the black rhino back in the 1930s with his wife, we traveled to the town of Mto wa Mbu, or mosquito river, that sits at the entrance to the national park bearing the name of the lake. Traveling past the entrance, Olive baboons roamed the road as they usually do, traveling to or from whatever food source they had been scavenging.

Leaving Mto wa Mbu, we ascend out of the valley and along the incredibly steep escarpment gaining some 2000 feet in elevation in a matter of minutes. At the top of the climb sits the village of Manyara and the Manyara airport, where we had flown into from the Northern Serengeti many years ago on our very first visit. The other significant feature here is that this the home of the African Galleria, an art and gift gallery that is owned by two brothers and close friends of mine, Nish and Punit. Pulling into their parking lot, I was thrilled to see the volume of safari vehicles which meant that the tourist trade was indeed recovering for their sake given that the last two years have been pretty disastrous for what is Tanzania’s main source of income. They have also built a fabulous restaurant here at the Galleria that I have visited many times in the past and Nish invited us for drinks today as it was the late afternoon. Their signature drink is the Dawa, meaning “medicine” in Swahili, and it is indeed something that will cure whatever ails you. Having just driven across the dusty landscape for two hours, it was definitely very much appreciated, even given the tremendous jet lag and sleep deprivation we were suffering after having traveled well over 36 hours by this point.

Karatu and FAME were only another 30 minutes up the road and we arrived safe and sound to my Tanzania home where Prosper, our volunteer coordinator, met us at the Raynes House to give us the keys and get us all moved in. I had messaged him earlier to make sure there was plenty of hot water ready for us meaning that the askari would have to fire up the kuni boiler, but this wasn’t an issue and seeing the smoke rising made us all realize just how exhausted and dirty we really were after this long journey. We ordered dinner from the Lilac Café here on campus and even though it took well over an hour for it to arrive, we were all incredibly happy to be here, but no one more than me. After our journey of over 8000 miles, we were all quite exhausted and ready for sleep. Tomorrow would be everyone’s orientation to FAME and patients would start late morning, right on schedule.