In the history of our neurology program here, we have very often been without a child neurologist and even though I have taken care of children for my entire career, I will be the first to admit that I am not a child neurologist and that evaluating neonates or floppy infants is certainly not my forte. Having trained in a program where our pediatric exposure was very broad, I have always been comfortable with pediatric headaches, seizures, Tourette syndrome, or even a bit of ADHD, but evaluating neonates with hypoxic-ischemic encephalopathy or metabolic disorders would cause any adult neurologist to run for the hills or cry uncle in short order. So, having our only pediatric neurologist, Cara, depart this morning for some well-deserved time with her boyfriend wasn’t something that I was necessarily looking forward to for today or the next three weeks as she wasn’t going to be replaced with the new group coming in.

The rest of us went to morning report and upon showing up for clinic, which was not incredibly busy, decided that it would be reasonable to make the clinic a half day so everyone could pack as they were departing tomorrow for the airport while I would be staying here for another three weeks with the new group. As luck would have it, of course, almost immediately following Cara’s departure from FAME around 10 am, the little baby who had presented earlier with status epilepticus decided that he would come back after again going into status despite having taken all of his medicines while home. Alana and Anne decided to head over to the ward to handle the situation with the child who was actively seizing at the moment. After loading with more levetiracetam and still having seizures, we made the decision to give the child a valproate load which he promptly vomited, but we were able to get him to hold down a second dose by adding some ondansetron. That stayed down and at that point it was a bit of wait and see strategy, though I’m not certain that any of us were entirely confident of the situation.

The rest of the morning was spent seeing the few stragglers that we had asked to come in the last day, but we hadn’t made this a fully scheduled clinic day to begin with so that we could wrap things up without having to scramble at the last minute for everyone to pack. They all enjoyed their last serving of beans, rice and mchicha with a pili pili on the side, although for Alana, it was again more like a lot of pili pili with rice, beans and mchicha on the side. If there such a thing as a pili pili bush, Alana would wish for acres of them. After lunch, everyone decided to head back to the house to relax and back while I was hoping to get the rear door latch fixed on Turtle as it had been acting difficult for the entire trip, not wanting to latch shut until I finagled with it for several minutes, splashed some water on it, and finally said a few curse words, whereupon it would finally decide to shut.

I drove the vehicle down to see if Soja, the mechanic in town I’ve used for years and who also fixes all of FAME’s vehicles, was in and could possibly work on it. A teenage boy came out of Soja’s home and upon seeing me, came over to the workshop where I had parked. Without speaking any English at all and my few words of Swahili, I was able to explain to him what the problem was and he was intent on fixing the problem for me. Over the next 1 ½ hours, he took removed the entire latch and lock assembly, opened the latch box ,which had been riveted shut and had to be drilled out to open, cleaned everything meticulously with gas and solvent, then oiled the mechanisms and rebuilt the latch assembly, finally reinstalling everything in excellent working order. When I finally asked him what I owed him, he said 10,000 TSh, or about $4.30! Arguably, there were no new parts that were involved along with their cost, but he had spent at least 1 ½ hours of time working on this problem and knew exactly what he was doing the entire time. I thanked him profusely and gladly gave him 20,000 TSh, even still with the feeling that I was somehow underpaying him for the service that he had provided.

I arrived home to find everyone having mostly taken care of their packing and were now in the hammocks relaxing and reading their books. The weather was again gorgeous today and we had finally decided to take a nice walk through down through the brick quarry that sits below FAME and then up the other side. The quarry, which has been a steady fixture here since the very beginning of FAME, is one of the many quarries in the area where workers dig the clay, form the bricks, stack them, fire them and then sell them throughout the community. It’s a slow process that is done continuously as there are bricks that are always in various stages of the process lying about throughout the quarry, the most noticeable of these being the very tall stacks of unfired bricks with the openings at the bottom for the wood to be placed. I’m certain that this is an incredibly ancient process that has been carried out in exactly the same manner for thousands of years and has become no more mechanized now than in the past.

We descended the steep trail that is heavily trafficked by man and beast and leads from the road just below the FAME entrance gate down to the quarry. In the dry season now, it is incredibly dusty and the creek at the bottom that must be crossed to reach the larger part of the quarry was bone dry. During the wet season, though, the creek is often very full and can be a challenge to get across at times. I remember Danielle Becker and I climbing up the trail in the wet season and finding the trail to be incredibly slippery, especially in the rubber rain boots we were wearing to save our shoes from the mud. There were workers attending to the various stages of the brick making process as we passed through and for those close, I gave a “pole kwa kazi” to which means “sorry for your work,” and is the polite thing to say to someone who is in the process of working as you pass by.

On the far side of the quarry was the Tloma Village Road that would lead us in the direction towards the village of the same name, with a steady incline as we seemed to attract the local school children wanting to walk with us for a ways, then finally departing. Tloma Village is one of the main Iraqw centers here and where many of our patients come from. As we reached the Gibb’s road, we had the choice of continuing on to Gibb’s Farm or turning around and heading back the same direction. As it was getting late, we chose the latter and made our way back in the direction of the quarry and finally back up the steep other side on our way home to FAME. We had a group of young boys following us up out of the quarry who were laughing and joking, all of which was our expense I believe, but there were no worries.

We were almost home now and it was this teams last night. I would be staying on another three weeks with the new team coming on Sunday. The request for tomorrow morning by the team was to sleep in and given there was no morning report on Saturday, this would not be a problem. We had no morning report, no clinic, no patients and not a worry in the world. My only responsibility now was to get them to the airport tomorrow night for their flights home and then pick up the next team the following morning. We planned to leave FAME around noontime, stopping by the African Galleria for lunch to have their wonderful cheese samosas on our way to Arusha and one last stop at the Shanga Shop before making our way to the airport. Alex, Moira and Alana enjoyed their continued game of Bananagrams while I sat blogging. It was a very relaxing last evening for them and a wonderful end to their three weeks here, at least from my perspective. By the next morning, I received notice that the new team had successfully departed Philadelphia and were on their way.