In addition to discussing our patients, morning report is a time for any announcements to be made and today was Alicia’s last morning at FAME after having been here for two months as part of her global health fellowship. She spent the first month as the only volunteer here at FAME which one might imagine could be rather lonely, though it is also a time where one is forced to become a part of the routine here rather than hanging around with the other volunteers as is sometimes easier than making new friends. In the early years for me here at FAME, there always seemed to be other volunteers that were here at the same time, though it was only one or two at a time. Later, when bringing the residents, my role drastically changed as I was in charge of the group and most of my time was spent making sure that everyone and everything was taken care of and in the right place. During my one visit in the fall 2020, during the height of the pandemic and prior to vaccinations, I was here alone, but by that time I had become a fixture at FAME and everyone knew me, a much different situation than if you were here volunteering for your first time.
So, after morning report, Alicia spoke to the staff about how amazing her time was here at FAME and how much she had learned in addition to how much she had been able to pass on to the staff regarding maternal care. In my role as a board member of FAME, it had been clear to me that the benefits of her involvement had been tremendous, both in regard to deliveries as well as prenatal care, and that her visit would have a lasting effect on the staff and patients here. Having relationships such as these for global health fellows that come on more of a long term basis is extremely important. Alicia had come through a relationship with Creighton University, that had been established several years ago and had previously brought a surgical fellow, Dr. Kelly, for an entire year, and Dr. Alyssa, another OB/Gyn who had come in 2020 prior to the pandemic. Our hope, of course, is that these fellows with eventually also become long term volunteers who will continue to visit FAME in the future, though even if they don’t, their positive impact on the health of the residents of the Karatu district will be long lasting.
We started out work for the day with our little baby in the ward who had been seizing overnight and was now in need of making a change. The decision after last night’s discussion with my peds neuro fundis (experts) was that we would put him back on phenobarbital, but not a loading dose given all the other medications he was on. We spoke with mom, who has actually been incredibly patient with us given the difficulty we’ve had in controlling her son’s seizures, and informed her that we were going back to the phenobarbital and our hope was that he would stop seizing or at least that they would slow down significantly. While seeing the baby this morning, he proceeded to have a seizure for us during rounds just to prove the point that something needed to be done. As he had an IV in, we decided to go with IV phenobarb as that would get on board the quickest. Sure enough, his last seizure of the day was around lunchtime and, after that, they reported no seizures at all to us for the remainder of the day. The baby was sedated throughout the day, of course, but was still arousable and, most importantly, still breathing. Finally, we were making some headway with this child.
The clinic day remained rather slow which allowed a good amount of time for the residents to do some neurology teaching with our translators, who also happened to be clinical officers and could greatly benefit from the additional time for education. Going over such topics as management of headache, and migraine specifically, back pain, epilepsy, and the neurologic examination were all areas that were incredibly helpful for them to work on during these downtimes. Unfortunately, we’ve had more of these lulls in patients than we would like, but there’s very little that we can do to change things and there are times that we wonder whether we’ve actually stamped out neurologic disease in the Karatu District. As quite unlikely as that was, it still crossed our minds.
At one point, Kizitu, who is in charge of all nursing services here at FAME, and is also a Maasai, came by to check on how we were doing and ended up answering questions from the residents as they were curious about his tribe and their culture as they make up a significant portion of who we see here, along with the Iraqw, who are the other tribe that we see in significant numbers here at FAME. Interestingly, it has been these two tribes, the Maasai and the Iraqw who have been at odds in the most recent past, not signing a treaty until 1986 to ensure their continued cooperation. The Maasai are pastoralists, acquiring wealth through there large herds of cattle, goats and sheep, though it is traditionally cattle that are their main source of food, eating the meat, drinking their milk and also their blood on special occasions. This practice (the milk and the meat, not the blood) and the fact that everything is unprocessed, actually exposes the Maasai to an infection that is seen here commonly called brucellosis, though on rare occasions it can actually develop into neurobrucellosis which then becomes much more serious and our problem.
The Maasai are probably the most well-known of the Tanzanian tribes (there 128 culturally distinct tribes in Tanzania) for their colorful dress, their way of life (mud huts grouped into a family unit, or boma) and their warrior reputation, though it is also due to the fact that tourists traveling here have the greatest exposure to them as they live in and around many of the national parks and the game reserves. More recently, there has been tremendous controversy regarding the Maasai living in certain areas and especially the Ngorongoro Conservation Area, where they have become extremely overcrowded over the last thirty years and have greatly encroached on the resident wildlife such that the government has proposed moving them from what they consider are their ancestral lands. This struggle is still ongoing today and a lasting solution is still in the works.
Regardless, the Maasai, who make up a significant portion of those who work and are seen at FAME and also live in the Karatu District, are an extremely proud and culturally profound group of people who I have become very close with during my work here at FAME and have found them to be a both wonderful and unique people. The Maasai range throughout Northern Tanzania and most of Kenya and though most of them speak Swahili, many who are from the more remote areas speak only Maa, their traditional langue, making translation for these patients often a three-way affair.
Once clinic was finished for the day, it was time for me to bring everyone over to Teddy’s shop for them to select fabrics and then decide what each of them would like to have made with them. I had first met Teddy several years ago when I was introduced to her by our former communications director here a FAME who had used her for having clothes made. Teddy’s original shop was just off the road past Carnivore, a local’s bar and restaurant that served only grilled cuckoo (chicken) and chips and had a tiny dance floor – Carnivore has now been replaced by the Golden Sparrow, which was built by the same owner. From the very first time I had met Teddy, I was sure that she was the one who would best take care of my residents going forward and we have never been disappointed.
Teddy has now moved to her very own shop which is in her home on the far side of town and, even though a bit further for us, it is an outing that everyone enjoys. She has a small duka (shop) that carries lots of general supplies for the neighborhood and then also has her fabrics and sewing machines. In the past, we would typically first go to a fabric store to pick out the patterns that everyone liked, but just recently, Teddy has acquired a great number of these incredibly colorful and distinctive fabrics for sale at her own shop, so it was now only a matter of going there rather than having to make two stops.
Everyone found fabrics that they liked and began to give her their patterns for the clothing they wanted made while she diligently began taking everyone’s measurements and putting them down in her notebook with tiny swatches of each fabric she was to use to make the piece of clothing. We had brought Mary Ann with us, and even though she didn’t want anything made as she does all of her own sewing at home, she did find two very nice pieces of cloth that she wanted to bring home and use. For me, I have never really had anything made, and even though I am totally enthralled by the colorful designs of the fabrics, they have just never felt comfortable on me for some reason and having something made that I would never wear just doesn’t seen like a good option. So, I live vicariously, enjoying bringing each group of residents to Teddy’s shop, them thinking it’s an imposition for me, when, in reality, it’s a total joy for me, both watching them go through their process of deciding on fabrics and what to make as well as the joy of bringing someone as deserving as Teddy this steady business for her shop. She takes care of the residents and we take care of her.