Wednesday, September 21 – A visit with Phillipo and dinner at Gibb’s Farm…

Patch Adams

I think everyone was still reveling in their visit to Daniel Tewa’s home last night as it has always been one of the favorite activities here. As you may have guessed by now, in addition to the work we are all doing at FAME in running our twice annual neurology clinic, as well as visits in between by other faculty from Penn, I have always tried to make this visit one of a more cultural nature so that everyone can get a good sense of the community here which is always so important in better knowing your patients.

Our waiting room before opening on a cool morning

Years ago, I had the privilege of meeting and spending time with the real Patch Adams, who was made famous by the movie of the same name where he was played by Robin Williams. He had come to my children’s school to speak and spend time with the kids through the help of their school’s educational foundation. He is an incredibly remarkable person whose activism in so many areas has brought benefit to people’s lives, one of which is through his clowning school where he brings his students from around the world to war torn and impoverished regions throughout the planet to spread joy and hope. The reason I bring him up here though, is for something he said to me, and which I will always remember, during the small cocktail gathering we had prior to his speaking to the entire community.

Kizito, FAME’s head of nursing, and me discussing Epic (Penn’s EMR) and FAME’s EMR

He told me that whenever he saw a new patient, he went to their home for several hours so that he could better know the living environment of the patient he was about to treat for how could a doctor think that he really knew a patient or the challenges that the patient may be facing without first doing this. As incredibly impractical as this may sound, and there would be no way to implement this in our current health care system in the US, which is already broken, by the way, it does make a lot of sense on so many levels. How can one really provide all of the necessary care for a patient if they have little understanding of the patient’s cultural make-up, their beliefs, their resources, their understanding, or their living environment. I would be the first to say that this would be virtually impossible to implement in our current system, but perhaps there are ways we could do better and I am always hopeful that there are some simple things that each of us can do towards meeting this challenge part-way.

Cara super exciting as we’re departing from FAME for coffee and Gibb’s Farm

Bringing the residents from the US to come here and work with patients who come from an entirely different cultural background that is half-way around the world and asking them to even begin to understand these differences may actually be the first step towards solving this dilemma for when they return home after this experience, my hope is that they will have an increased awareness and sensitivity to these subtle, or often not so subtle, challenges. Working in a country with a completely different language and with patients whose culture and living environment are so vastly different than ours clearly accentuates this conundrum far beyond what we are normally dealing with at home, but yet it is also very similar.

Even when both parties are speaking English, there is quite often a difference in understanding that may go far beyond any benefit that speaking the same language may provide. And then there are the issues of health literacy that bring us the next level in this discussion. The residents visit homes of Tanzanians from various cultures and levels of social status and work with Tanzanian healthcare providers who also help to provide additional insight and, through all of this, will gain a better appreciation of the patient that will hopefully make them better, more compassionate, and more understanding physicians who will be able to provide their patients better care through having come here.

There was no educational lecture this morning, so once again, everyone appreciated the extra half hour of sleep. There was also plenty of time after morning report for the group to make a trip to the Lilac Café where they could focus on their need for caffeination. I will have to admit, though, that I have also benefited from their habit as I’ve enjoyed this morning cup of Joe along with them, something that I haven’t done at home for several years. I still don’t feel the urge, so I am confident that once home, I’ll revert back to my previous schedule. Clinic today was not overly busy and Cara got to see her normal share of children with delayed development, who by the way, will be coming over the next three weeks even though we are going to lose our child neurologist when she leaves at the end of the week. I’ve been doing it for twelve years, often without the benefit of a pediatrician, so we will make do.

Lunch today was once again our favorite, beans and rice with mchicha and lots and lots of pili pili. Even though we have all enjoyed the pili pili here, it has been Alana who has taken to it the most and I often think that her portions of this delicious Tanzanian salsa exceed that of the rice and beans. She will frequently go back to put more on her dish and we’ve now come to ask Samwell if we can have his fresh pili pili at the house for dinner rather than using the bottled variety. I think we go through over half a small jar of this for each dinner and God help the individual who uses up the last drop if Alana hasn’t gotten her aliquot that night (maybe that’s a bit of an exaggeration, but she is totally i love with the stuff!).

The afternoon was running a bit slow and we were able to slip out of clinic at a decent time so that in addition to our dinner plans at Gibb’s, we would have time to visit with Phillipo and his family, our coffee supplier. We had found Phillipo a year ago while on a walk to Tloma Village and the Makunde wood carver who I knew. While there, he invited us to visit his friend next door who is a small coffee grower and what was initially an impromptu visit, turning into an hour long tour of his coffee making operation including enjoying some of his fresh pressed coffee that his wife brewed up for us. Phillipo has about five acres of coffee bushes that he grows and harvests and then processes and roasts. The land was passed down from his father who is also the one who taught him how to grow and process the coffee.

In an area of enormous coffee plantations and one of the world’s best coffee growing regions, Phillipo is a small grower and family run operation with his wife, his father and his two small children all participating in the various processes of growing, drying, shelling, fermenting, roasting and bagging the coffee for sale. In addition to the coffee, though, he also has dozens of beehives around the property for the small stingless bees that fertilize his coffee plants. They produce honey that is heavily coffee flavored and really wonderful. I had tried to bring several bottles home last year, but they didn’t last for whatever reason and I suspect have to be consumed much faster than I had anticipated.

Relaxing on the veranda at Gibb’s Farm

As we arrived, we were greeted by the entire family. We had called ahead, not only with an order of coffee as everyone was buying some, but also to let him know to prepare our order if possible so we could pick it up and bring it home with the departing residents. His wife was sitting at her sewing machine, busily stitching bags out of kanga cloth of different designs that her children then thread the tie through on the top. His father was cranking the coffee roaster by hand and, when that batch of coffee had finished roasting, it was dumped into an open container with a screen bottom for the coffee to cool and be ready to either be packaged whole or then ground, also by hand. The entire process was demonstrated, including the shelling of the coffee and removing the chaff, again, all by hand.

Quite happy at Gibb’s Farm

During all of this, his wife also brewed us a fresh batch of coffee in a large French press that was delicious and meaningful, as were all siting there in the midst of this coffee operation drinking the product incredibly fresh. Their two children are lovely and I will enjoy watching them grow over the years as I plan to visit Phillip and his family on every trip as it was again something very much appreciated by the residents and another example of visiting people’s homes to better understand the culture here. I think we could have remained at Phillipo’s forever, but eventually another large group showed up from a nearby lodge, having walked there, and I felt it would be appropriate for us to move on and let his focus on these new clients, who I am sure were going to buy coffee from him as well. It’s so rewarding to see how successful he is as he and his family deserve it.

Dinner at Gibb’s with Nish at the far end

We had made reservations at Gibb’s Farm for dinner tonight and getting there early and well before sunset is always a major advantage as their veranda overlooking the entire valley to the west, with the endless coffee fields below and the incredible foliage around the main farmhouse, is an incomparable setting as are their cocktails while enjoying this view. Sitting in these lounge chairs with a drink in hand and taking in the surroundings, it is impossible for one to have a care in the world and the well over-used phrase “life is good” comes to mind, but one knows that it was really created for these moments alone for there is simply nothing better than this.

Our menu at Gibb’s

I have been visiting the Gibb’s Farm since I first came to Tanzania and for that entire time, it has been a sanctuary among sanctuaries and a place that one visits to cleanse their mind and body. Driving through their gate, or even writing this blog and thinking about it as I am doing currently, will cause a general decrease in your blood pressure and heart rate and your stress level begins to precipitously drop. Tonight, there was also going to be a performance of the Tloma Village Choir, a choir from the village here, that would be singing traditional Iraqw and Tanzanian songs around the pool. Their pool area also has an equally incredible view as the veranda and listening to the group with this wonderful backdrop was stunning. All of the other guests of the lodge were there for the same experience and the fact that we had been invited was another benefit of volunteering at FAME as they are happy to have us come and enjoy ourselves for the work we do for the community.

After the choir finished, we sat down at our dinner table in the farmhouse and proceeded to enjoy an incredibly delicious dinner that was mostly farm to table. Nish had come up to join us and we had Dr. Anne with us as well and it was a relaxing and fun dinner with lots of conversation and camaraderie. I have known all of the staff at Gibb’s for many years, many of who have come to see me or have brought their families to see us and we always receive a warm welcome from them as one can imagine. Being here to provide the services we do at FAME and for the Karatu district is something that is highly valued by the community and they are always incredibly appreciative when we visit anywhere. The personal rewards that one receives from volunteering anywhere is impossible to measure by any standard means.

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