It’s once again that time of year for our group to head over to East Africa and, for me, it has become so commonplace that it seems I’m either having just returned or preparing for the next expedition there. For the first time in the nearly ten years that we’ve been doing this, our last trip in the fall was comprised of two three-week blocks for the residents with two groups traveling there. The reason for this is to accommodate the number of residents with an interest in global health and wishing to participate in this unique experience of learning to practice in a low resource setting quite unfamiliar to most everyone practicing in the United States or anywhere in the developed world. Yet this is how medicine is practiced in nearly all of Africa, where there are not only limited resources, but also an incredibly limited number of specialists such as neurologists. The burden of neurologic disease, though, as it relates to mortality and morbidity throughout the world is a staggering percentage and, hence, the need for greater exposure to this discipline quite familiar to me for the frontline clinicians who are providing the vast majority of healthcare throughout the developing world.
We are in the air somewhere over Eastern Europe at the moment, or at least that where I imagine us to be, and less than four hours from our first destination, Doha, Qatar. Everyone’s on board – Mark, Anya, Usha and Wells – the four residents who will be with me at FAME for the first three-week rotation, shortened by one week from the prior four so as to make sure everyone who wishes to will have a chance to come. In three weeks, we’ll be heading back to Arusha to drop this group off for their return trip and to pick up the residents from group 2. I hadn’t realized the extra work it created for me to have two groups doing the same thing for it requires teaching everything all over again to make sure everyone’s comfortable. Dropping a set of “experienced” residents off for their return trip and to pick up a group of “greenhorns” the following morning was something that I hadn’t accounted for, but it’s a learning curve and I’m sure that knowing the situation in advance this time will make it a bit easier for me.
I do have a fellow traveler along with me this time and am very much looking forward to introducing her to my other home in Tanzania. Jill will be sharing all our experiences in the Karatu region – Ngorongoro Crater and the Serengeti, Gibb’s Farm and the African Gallery, Golden Sparrow and, best of all, Turtle – while also volunteering at the Black Rhino Academy, only a stone’s throw from FAME. Jill is an early education specialist who has always had a dream to work in at a foreign school and will now get her chance after having retired a few years back from the Pennsauken School District after teaching kindergarten there for many years. With an overweight suitcase full of children’s books and school supplies (popsicle sticks, colored pencils, and the like), she will head off Monday morning to begin her month at the Black Rhino Academy (known for having one of the very best football pitches in East Africa) working with the young children and teachers there.
This trip will also include an in-person Board of Directors meeting for FAME, something that had last been planned to occur in March 2020, but we all know where that ended up. Having been at FAME with my group that March, I well remember the tense moments as the pandemic gripped our country back home and the world stood in panic. The board meeting was obviously cancelled and our group lasted three of the four weeks we had planned before we had to scramble home when they announced the border was closing and you either had to return home or shelter in place. Somehow, I didn’t think that our program would have been fond of the residents spending months here in Tanzania until the borders reopened and we could return home. Threatening to close the borders and everyone returning home all at once, though, threw the airline industry into mass confusion, though, stranding many folks and causing others to have to pay exorbitant amounts of money to rebook their flights home or somewhere close by. After all was said and done, the Center for Global Health (thank you, Maria!) at Penn managed to get flights rebooked for most of us with additional costs, though they ended up flying us into JFK on the return which was ground zero for the pandemic at that time and much like a zombie apocalypse on our arrival there. Though we were offered flights from JFK to Philly, I had no interest in getting on another plane at that moment, and so, we made it home in a rental car no worse for the wear. Those are stories to tell your grandchildren, or at least that’s what we tell ourselves.
After an eight hour layover in Doha (not a bad airport for a layover with all the shopping), we’ll be heading down to Kilimanjaro International Airport, nestled near the foot of Mt. Kilimanjaro and midway between the picturesque town of Moshi, with its medical school and climbing hotels, and the crowed and dusty burgeoning metropolis of Arusha, once the home of the UN Rwandan tribunal for many years and now with likely plans to be the capital of the East African Community in the future. Our flight to Kilimanjaro will be much shorter at 6 hours than the behemoth 12-hour flight we’re currently on from Philly to Doha. This next flight will depart around 1:40 in the morning, which is not incredibly pleasant, though it gets us into the airport at around 7:40 am with a full day ahead of us.
Leonard and Pendo, or the Tembas, are my Tanzanian family who I have now known for 14 years after Leonard was my safari guide when I traveled there with my children in 2009 and what now seems like a lifetime ago for so much has transpired since that fateful trip. Little did I know when I had booked our adventure that it would change my life forever and take what had already been a wonderful and fulfilling career to entirely new heights. I have watched the two older Temba boys grow into incredibly handsome and fine young men, currently finishing their schooling in Nairobi, and now can also share in the lives of their two younger children, who have come along while I’ve been traveling back and forth to East Africa.
I owe everything to Leonard for having introduced me to FAME in the first place, thinking at the time that he was going to merely bring me to some small local clinic, when instead I discovered this Mecca of healthcare in Northern Tanzania that had only just opened the year before I visited there for the first time. What was only a dream of Frank and Susan’s at that time, FAME has grown over the years that I have been visiting into a true medical center that now has a hospital designation and serves as one of the most respected medical institutions in the country. Only a single outpatient building in 2009, FAME now has a hospital, a 25-bed free-standing maternity ward, laboratory, radiology department, complete with a CT scanner, and has just broken ground for a new 10-bed emergency room that will provide state of the art emergency care where there was none before.
So, coming full circle, the three adult neurology residents and one pediatric neurology resident will be accompanying me to this truly amazing healthcare facility that is FAME Hospital (no longer just FAME Medical), providing patient-centered care to a population of Northern Tanzania where access to healthcare of any kind, let alone state of the art healthcare, is incredibly difficult to find and resources are often nearly impossible. It is in this setting and with the help of FAME, that we have now provided sustainable neurological care for patients and education for the clinicians where there was no neurology before and have managed to do this for over a dozen years and even in the midst of a worldwide pandemic. It is in these small miracles that our humanity will continue to shine bright.