Wednesday, September 7 – A very cool and quiet day…


Alana with Charlie at his favorite spot for lunchtime – next to the cantina waiting for handouts
Alana and Matilda

I am always asked about the weather here in Tanzania as it seems to be the general perception that the entirety of the African continent must be either hot and humid or hot and dry, with the emphasis on hot. The fact of the matter, though, is that the weather here varies by location as much as it does anywhere in the world and other than the lack of seasons as we know them back home, it is absolutely gorgeous here in Tanzania for perhaps eleven out the twelve months each year. Rather than winter and summer, we have the dry and wet seasons and when the monsoons come in late April through May, it is not a pleasant place to be as the roads are impassable and everyone seems to hunker down until it’s over. I was here one during the raining season and after trying to drive to mobile clinic in Kambi ya Simba only to be stuck in the mud for hours in my Land Rover, which isn’t supposed to happen, I decided to adjust the times that I come to avoid that in the future.

To give everyone a good perspective of where we are, Karatu is 370 km (230 miles) south of the equator and sits in the what are referred to as the Ngorongoro Highlands of Northern Tanzania. I am sitting at an elevation of 5180 feet as I type this blog on the foundation of the outpatient clinic of FAME. We are by no means at the highest elevation of the Highlands, though, as you have to ascend another 3000 feet to reach the high point of the Ngorongoro Crater rim road where will be on Sunday as we take our first game drive. By the way and just as a point of clarification, the Swahili word “safari” has absolutely nothing to do specifically with driving around viewing and photographing (or heavens forbid, hunting) wild animals. The word safari merely refers to one’s journey or travels and so it is perfectly natural to be asked “How was your safari?” when you arrive after your plane flights to get here. Somehow, though, the meaning of the word was westernized to refer to the former activity, but beware that it is not used that way when in a Swahili speaking country.

In addition to being the home of the largest dry caldera in the world (Ngorongoro Crater itself) and being the gateway to the Serengeti from the east, the Ngorongoro Highlands are an incredibly rich and diverse region, both culturally and agriculturally, as it is home to a number of prominent tribes and also the main coffee growing region of Tanzania. FAME sits amid the most incredible coffee plantations and other than tourism, coffee picking is the other main seasonal occupation here for the local population. Unfortunately, other than the coffee brought back by tourists here, little goes to the United States due to the economic history of Tanzania which has been dominated by the East, and specifically China, following Tanzania’s independence in 1961 and union with Zanzibar in 1964.


The dominant geologic feature here, though, remains the Crater, which is ten miles across and 2000 feet deep and is the remnant of a massive collapsed volcano, so is technically a caldera and not a crater. It is the home to enormous populations of animals that includes essentially everything you would expect to see in the Serengeti other than giraffes (the walls of the crater are too steep for them to descend) and the Nile crocodile (there are no continuously flowing rivers there). Most importantly, though, it is one of the homes to the endangered black rhino, a smaller version of the more southerly and populous white rhino. The animals in the crater are also unique in that they do not migrate like the other herds of wildebeest and zebra do as the grasses here will support them year round. The crater is my absolute favorite place to drive and bring people to as it has never disappointed.

Matilta training Cara

Our day started rather slow with patients and remained that way, which I thought had been due to the weather being so unseasonably cold, but later realized that today was one of Karatu’s Maasai Market days. Twice a month, locals from the entire Karatu district travel to the fairgrounds just out of town to buy, sell and barter for just about anything one could possibly imagine needing. It is a massive market with thousands of vendors, artisans and farmers, livestock everywhere (I have forbidden my residents from bringing home a live animal), food vendors selling anything traditional and all the clothing that has been discarded from the US and sent here, some used, but also much of it new. Huge blocks of compressed clothing, all of it donated, are shipped over on freighters and then sold to vendors who transport them to the various markets for sale.

These blocks, which are 4x4x6 feet in dimension, have compression straps around them which, when ready, are cut with the entire block then tumbling into a giant mountain of clothing that may or may not be sorted by the vendor prior to the separate items being available for sale. Not only can you find any brand of designer clothing here, but also virtually any collegiate piece of clothing and, perhaps most comically, the discarded Super Bowl t-shirts of the losing team incorrectly announcing their championship. In the end, though, the Maasai Market is a huge sensory overload that serves its purpose for those residents of Karatu  and other locales that need a market such as this to provide them with essentials for their livestock and their own daily lives. If you ever have the chance, I would highly recommend reading “The Blue Sweater,”  a wonderful book that deals with the author’s journey through African microfinance, friendship and betrayal, all that occur in the backdrop both before and after the Rwandan genocide.

Of our patients today, there was again a smattering of diagnoses with the most interesting perhaps being a young man that reported having headaches that would occur every time he would smile and would last only about 30 seconds or so. Though just telling him not to smile certainly seemed like it would resolve the problem, but really wasn’t an optimal solution after all. We actually had really no idea as to why he was having these headaches and didn’t want to put him on a medication for now reason at all, even though that is what is often what patients would like us to do as it may be their expectation. In the end, given his normal neurologic examination and otherwise entirely benign sounding symptoms, we chose to reassure him that there was nothing seriously wrong and if he developed any other new symptoms to return.

There were a number of reasonably complex epilepsy cases that took a bit of detective work to figure out what medications they had been on in the past and what doses, which is always an issue given the lack of records that often exist here from other institutions. Alex saw a young woman with a mild hemiparesis who had been having multiple daily focal seizures for over twenty years probably following an ischemic event at a young age who just needed to put on an adequate dose of antiseizure medications. And Cara saw a very likely HIV-related neuropathy patient, probably more common here than we’d like to think.

Our clinic actually ended before 4 pm today, which is by far the exception for us, and we took the opportunity to all take a nice brisk walk together on a circuit that I’ve taken now for over twelve years. On my very first trip here in 2010, I had decided to walk to a distant ridge in the Shangri-La coffee plantation to get a photo of sunset, only to realize that I had no flashlight and this was in the day before our iPhones had flashlights. I had walked more than an hour to get to the ridge to take the photo of sunset (which, by the way was very disappointing), and now had the same distance to walk back in the pitch black darkness that exists here once the sun sets. Think along the way home that I had seen every dangerous wild animal is not an understatement, though I wasn’t prepared for displeasure shown by Carolyn and Dr. Joyce, the two other volunteers I was staying with who had been worried sick about me the entire time.

Today’s walk was much better planned and we all did a brisk pace traveling through some local fields initially and then onto a small trail in a very large loop that had fantastic views of the hillsides surrounding FAME and the Ngorongoro Conservation Area as it comes down to meet the coffee plantations. It was not warm, but with our pace, we easily broke a sweat and made the large loop that has been as staple of every volunteer group since the beginning. It is impossible not to fall in love with this place for this scenery alone. We walked just over 2.5 miles at about 3 miles an hour including our stops along the way and were back home in plenty of time to enjoy our special gin and tonics before our dinner of mashed potatoes, ground beef and mchicha that was delicious, though anything here tastes amazing after a long day.

Making popcorn

Our evening finished with a movie night watching The Birdcage and enjoying some popcorn that Alex made, his very first on the stove. He seemed a bit skeptical as I described for him how to do it, but in the end, trusted me enough to get things started and it ended up turning out great. Everyone loved the movie, one of my favorites, as well the play on Broadway (La cages aux folles) and drifting off to sleep tonight, the world just seemed to be a better place for all.

’nuff said

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