Tuesday, October 4 – Back to Mang’ola for another day and clinic in Mbuga Nyekundu…

Standard

After the exhausting adventure we had yesterday, it was up early for our educational lecture today and then back on the road to Mang’ola and the village of Mbuga Nyekundu. This morning lecture was given by Mary Ann and had to do with abnormalities you visually note in babies at birth and what they may or may not indicate as far as an underlying defect. Though most are totally benign, others are significant enough observations to suggest obtaining a CT scan of the brain (for example, excessive or multiple hair whorls may indicate abnormal brain development).

Map of the Mang’ola region

Our drive for the day was essentially the same as yesterday, though we would turn off earlier before cresting over into Barazani and, instead, travel more inland from the lake towards the hills. We had actually driven this same route when returning last night from Pendo’s home, Majiyamoto, though given the darkness that had quickly enveloped us, none of my passengers would have known that we already driven this road. Once again, a long and terribly dusty drive on the heavily rutted, or “washboarded,” road that makes you feel as though all of your fillings will soon fall out if it persists. Thankfully, everyone’s dental work remained completely intact as the road continued on an on until we finally reached the village of Mbuga Nyekundu that sits in the foothills far above Barazani in the distance.

Announcement for our clinic

We had started visiting this clinic at a similar time as we had Barazani, though the number of patients here have always seemed to lag behind a bit, most likely a factor of the size of the village and the population. They have been enlarging the clinic, though, over the time we’ve come and though we were still in the same building we had used six months ago, which was new for us at the time, they already have another large clinic building under construction. The area itself is incredibly windy and throughout the day, it continued to howl excessively.

Starting to register patients

Patients were here early waiting for us and continued to accumulate throughout the day, but we were never swamped. There was one child who had traveled from Barazani as they had showed up late for yesterday’s clinic and there was some debate over what had been promised to them. Kitashu, who had been able to attend only the last part of yesterday’s clinic had spoken with the mom of this child, but there was a difference of opinion regarding what had been said between them. Mom was adamant that Kitashu had promised round trip transportation, but the driver of our other vehicle recalled only that we were responsible for trip to the clinic and not the return. I really wasn’t certain what the issue really was considering the other vehicle and driver were essentially leased for the day to bring us there and back and in between was pretty much down time. In the end, we were able to resolve the issue and the child was transported home with his mother and the crisis was averted.

Anne triaging patients

Most often the one to resolve these issues, Kitashu was not with us today, nor was Angel, our other social worker, so those duties were left to Dr. Anne who handled them seamlessly, though not without some friction as happened with the child’s mom above. Kitashu was enlisted to help with the group that was going out to find the family of the young boy who had died of rabies as the other family members were desperately in need of getting vaccinated as quickly as possible given their exposure to the boy prior to his coming to FAME. There was also the report that a sibling of the boy had also been bitten by the same rapid dog and now showing symptoms. Finally, when the family was found, the sibling was evaluated and, thankfully, not felt to be symptomatic so they received the vaccine in the same fashion as the rest of the family. Had they been symptomatic, there would have been little purpose in supplying the vaccine or immunoglobulin as neither would have provided any benefit. The entire family and anyone else who had come in contact with the child who had died was vaccinated. Though this will end the issue with this incident, there is little question that the problem will persist and there will be further exposures in the future.

Taha and Amos finally behind bars

Encountering a case of rabies in the US would be exceedingly rare for any of us given the rarity of the condition back at home, though they do occur from time to time. There was a case in the ICU at Penn within the last few years, though again, this is something that most physicians will never see in their career. Unfortunately, for Africa and other regions that are similarly depressed economically, rabies is far more common than it need be and is a significant public health problem. Dogs account for 99% of all human exposures to rabies worldwide and, therefore, aggressive campaigns for dog vaccination will ultimately reduce the risk of exposure for humans. Unfortunately, the same countries where these campaigns are most needed are those who are the least able to enact them due their economic issues.

Hussein speaking with a patient

The region of Tanzania where we had spent yesterday as well as today seeing patients, and especially last evening visiting Pendo in her home, is a very culturally interesting area for the diversity of tribes that inhabit it. This is the Lake Eyasi region that is very remote and definitely feels like you’re traveling back in time. The most unique of the tribes that live in this region is the Hadza, or the Hadzabe, who are the last hunter gatherers in Tanzania and also speak one of the click languages known mainly in South and East Africa as well as Asia. I had spent a significant amount of time with the Hadza during our larger mobile clinics in 2010 and 2011 and, during that time, found their language to be truly intriguing. On one occasion, I had accompanied Amir Bakari, a wonderful colleague who was working for another NGO, to visit a distant village during the rainy season to let them know the FAME bus could not make it to them due to the flooding of the roads. Two Hadza men had asked us for a ride to the other village which wasn’t at a problem other than the fact that they were both a bit intoxicated and, when they spotted a small flock of guinea fowl, decided both to shoot their bows and arrows out the open side windows of the vehicle. Given their state, they both missed the birds badly and then had to run outside to retrieve their arrows. What I remember most, though, was their laughing and cackling in the back of the Land Rover, all the time speaking click. I have videos of the drive focusing on the horrible roads we were driving, but the sound track is primarily these two Hadza in the back seat conversing.

Joel dispensing medications

What’s truly sad about the Hadza, though, is the fact that there are probably only 1000 of their tribe still living in the area and remaining true to their culture such that they are marrying within their own tribe and raising Hadza families. Their numbers have been reduced over time by the typical pressures that are placed on such small groups of people, but in this case, it is also the fact that their homesteads have been encroached upon by surrounding tribes, and mostly the Datoga who grave their animals through the Hadza region, running off the typical game the Hadza hunt. What has been left for them to hunt are small birds, dik dik and baboons as all the larger prey have been reduced by this encroachment. I recall hunting early in the morning with a group of teenage boys a number of years ago and being amazed by their accuracy in hunting small birds in the trees, but, in the end, coming home with a string of small birds to feed a small family isn’t something that is sustainable. I came away with an entirely greater appreciation not only for what it takes to “eat what you kill,” but also for the fact that the Hadza are a dying tribe and that both their language and their incredible uniqueness will soon be gone to this world. There are a number of groups working to save the Hadza, but it is unclear if these efforts will be successful or not.

Taha, Amos, Veronica and Nuruana at the end of clinic

One of the other unusual features of this area of the Karatu District and, perhaps, Northern Tanzania, is that there is an amazing amount of agriculture that goes on here, but they specifically grow huge crops of onions primarily and, for this reason, many of FAME employees who accompany us here will plan to stop on their way home to buy large amounts of onions. Dr. Anne and several of the others quite early announced their intention to stop on our return trip to get a 20 kg bag of onions for something like $3 USD if I remember correctly. No matter how you cut it, that’s a ridiculously small amount of money for a very large amount of onions.

Traitors eating lunch in the other vehicle

We left in advance of the other vehicle which was carrying all of the Tanzanians except for Nuruana and Amos as they had elected to travel home with us. It was a much better drive for me than the one the night before that had been done in darkness and when we returned home, it was decided that we would take it easy for the evening considering the busy days we had over the last two.

Always attracting a crowd of children. Finishing clinic with a fist bump

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