Having spent both of the two previous days on the road, I’m not certain that any of us realized just how exhausted we were after all the travel. I’m sure the drives were just as tiring for the others as it was for me, though having driven over an hour each way to Mang’ola both days, and in the dark coming home on Monday, I was more than ready to stay at FAME for the day as I’m sure everyone else was as well. Mang’ola is by far the toughest drive of the mobile clinics for the drives to Kambi ya Simba and Rift Valley Children’s Village, though challenging in a different way, don’t have that draining, high speed pace on bumpy gravel that always seems like you’re just a bit on the edge the entire time. For certain, the roads to the other villages are bumpy, but they just don’t involve the same nerve wracking challenge, unless, of course, it’s raining in which case they are like a slip and slide and that’s an entirely different story. Leave it say that even though the mobile clinics can be a welcome change, it’s always nice to be home.

Angel had started her annual leave, which is why she wasn’t available for us on Monday or Tuesday in Kitashu’s absence, but thankfully he was back with us today so our team was once again fully intact. There was no educational lecture this morning , so it was just morning report at 8:00 am and then our regular neurology clinic. Mary Ann was leaving today, so it was time for everyone at FAME to give her the standard three claps of appreciation always preceded by “pasha, pasha, pasha, choma,” neither of which the translation or custom I am quite certain of. I do like the three claps, though, as it never leaves anyone questioning just how long they should have clapped or feeling as though they may have ended early. I also said something about what a powerhouse Mary Ann is when it comes to fundraising for FAME, something that is absolutely essential and, without the donations that we receive from individuals, FAME would no longer have the ability to provide the life affirming services that it does to the residents of the Karatu District here in Tanzania.

One thing that I was really looking forward to today, of course, was our return to my favorite all time lunch – rice, beans and mchicha. The last two days, we had eaten box lunches that were from the Golden Sparrow and are typically intended for those guests going to the parks and to be eaten on the road. The lunches contained roasted chicken (typically a small piece consisting of a thigh and wing unless you’re lucky enough to score part of a breast), a bun and hot dog, a butter and carrot sandwich, a piece of chocolate, a mango juice box and a hard-boiled egg. Not that there’s anything at all wrong with the box lunch as it was very filling, but I would be willing to take the five day a week FAME lunch of rice, beans and mchicha over just about anything that someone could off to me. Last Saturday, when we had taken the day off, the residents went to the Lilac Café for lunch which I had originally planned to do as well, but just really could pass up the FAME lunch and ended up going with that instead. Somehow, learning how to make the meal at home just doesn’t seem like it would be the same, so I will just have to enjoy it here and know that I’ll have it again when I return.

Our day in clinic was slow but steady and we had actually planned to make a trip in the late afternoon to visit our friend, Phillipo, the coffee grower as everyone wanted to buy coffee to bring home for gifts and we had also wanted to visit another old friend of mine, Athumani Katongo, who is a wonderful artist that I had first met at Gibb’s Farm years ago. His artwork hangs in my office at Penn and over the years, numerous residents have also purchased his works. I had lost touch with him during the pandemic as he had moved from Gibb’s Farm, but I recently learned that he now had his work next door to Phillipo’s at a shop merely known as the “woodcarver’s shop” – also an old acquaintance of mine, Mbuga, who is Makonde from Southern Tanzania famous for their wonderful and very distinctive ebony wood carvings.

I had just recently learned that Amos, the clinical officer who has been working with us over the last weeks, was a very close friend of Athumani’s and also wanted to go to visit him when we did. As the drive to get to the woodcarver’s shop and Phillipo’s would take about 25 minutes, we had hoped to leave clinic a bit early, but as is usually the case, Taha’s last patient was a bit complicated as she was a 40ish year old patient with a complaint of left facial weakness, but also had other cranial nerve involvement in the same vicinity and a headache, all of which was new and made us very concerned for the possibility of a mass lesion causing her problems. She absolutely needed a CT scan of the brain with and without contrast, so both Taha and Dr. Anne proceeded to discuss this with her and the fact that she and her family would have to pay at least part of the cost for the study.

This is always such a difficult situation as FAME does not offer care for free, and even though there is a single charge for the neurology clinic that covers the visit, labs and medicines for at least a month, it does not cover radiology and certainly not CT scans. From the very beginning, it was very clear that FAME would not be able to provide care for no charge from the standpoint of funding and that patients would be charged reasonable and appropriate fees consistent with what was being charged by other healthcare institutions in the country. The benefit of FAME is not that the cost of care is any different, but rather that the quality of care which FAME provides exceeds what is available elsewhere in the country. FAME has succeeded in doing that, but must still charge for the care that patients receive.

Often, though, when patients are unable to afford a procedure or test, they must go back to their family or their village where they will speak with the elders who may then raise the money from the community to provide the necessary care. Unfortunately, when dealing with these situation, you quickly realize that there are always unintended consequences when dealing with these situations – reaching in your pocket to pay for the CT scan may work in the short term, but what if you find the patient has a problem? The expectation at that point is that you are responsible for the patient’s continued care and that is not a viable option. Unintended consequences are often the result of over zealousness and a failure to think things through to their most likely or possible conclusions.

Our patient needing the CT scan initially disappeared for around 15 minutes, but eventually returned and explained that she would be back the following day to obtain the study which, unfortunately, did not happen. In the coming days, we will have to reach out to her to follow up on this and make certain that everyone is on the same page. Somehow, we will try to do what’s best for the patient going forward.

We were eventually able to get away and, even though it was a few minutes later than we had wished, we were able to get there in the daylight so we could spend an adequate amount of time with Athumani’s artwork, which worked well for Sara, who found a wonderful painting of four Tanzanian women carrying fresh fish to the market in baskets that they were carrying on their heads. I loved the painting and, if Sara had not purchased it, I would have in a heartbeat as there was something about it that really characterized the people of Tanzania. He does a lot of very cool stuff with his art work using handmade papers and lots of the colorful cloth here to create a fantastic background on the canvas and then paints on top of that. The painting I have is one of an abstract elephant with an incredibly colorful trunk, but I’ve included one that he did for one my residents, Lindsay Raab, that she ordered specially from him.

We spent some time with Mbuga, the woodcarver, as well, though I’m not certain that we bought to much from him. The real highlight was once again visiting Phillipo and his family. They are such a job and the coffee he produces is the best, much of which is also related to the fact that he processes everything by hand right there on his farm and right in front of us. As we arrived, his father was roasting a fresh batch of coffee beans by hand and, one finished, put onto the cooling rack. We were there for enough time that the beans cooled and we were able to package and purchase that batch which made it all the better. We also spent time watching the stingless bees that pollinate his coffee plants going in and out of their hives. The larger “stinging” bees also try to steal their wax, but the smaller stingless bees have soldiers defending the hives. He also brought out some of the honey for everyone to try as it is equally delicious, but he didn’t have any to sell this visit which was unfortunate as I believe Ankita would have purchased his entire stock had he had any.

All in all, it was another lovely visit with his family. I can’t remember his wife’s name for the life of me, but his children, Elia and Elizabeth, are just fantastic and I’ve watched them grow over the last several years. I always love playing with them while Phillipo is giving his talk on the coffee process to the others. We drove home that evening incredibly satisfied with a boatload of coffee in hand and good sense that we had helped his family specifically by buying his coffee and it couldn’t have been more “direct from the source.”