I hadn’t mentioned the shida (trouble) that we’d been having with my stretch Land Rover, Turtle, for some time now, but in the end, it turned out that it wasn’t just a matter of replacing the cylinder head gasket as the cylinder head itself was bent and needed to be replace. This meant that we needed to find a used one somewhere as a new one would be too costly and new parts are tremendously difficult to come by here. In the end, we removed the cylinder head from another vehicle in Arusha, but also discovered that the fan and the reservoir cap for the coolant were also malfunctioning which both added to the issue of overheating with the car. One of the fundis (fundi = expert or specialist) from Arusha had been working on things and was shuttling back and forth to Arusha for the last several days.
I awakened with a phone call a bit before 6:30 this morning and, upon answering, discovered that it was Victor, the fundi, who had driven from Arusha early that morning to bring Turtle back to Karatu. He had anticipated driving the short Land Rover back to Arusha, but when I told him that we would still need it her here for our mobile clinics next week, it turned out not to be an issue for him. I drove him down to the bus stop and we now had two operational vehicles in Karatu which would make life much easier for us in the end. Despite the early morning awakening, I chose to remain awake for the remainder of time before our clinic was to begin. As there is no morning report on Saturday, it gave everyone extra time to sleep and me extra time to work on my computer. The weather has been amazing so far on the trip with gorgeous mornings and beautiful sunrises.
One of our patients this morning was a 26-year-old presenting with their third episode of psychosis that had now lasted nearly a month. The episodes began at age 7 making the diagnosis of schizophrenia very unlikely and we suspected that this was much more likely to represent a depression with psychotic features, they were a bit on the lengthy side as far as the episodes themselves were concerned. Her labs and examination were otherwise unremarkable and in between episodes, she was very functional. She had no abnormal movements either making something like Wilson’s disease quite unlikely. We ended up deciding to treat her with fluoxetine for her depressive symptoms and olanzapine for the psychosis. Beyond that, we would just have to see how she did going forward and hope for the best.
As for our young boy with Tb and who had presented with the focal examination and multiple mass lesions, quite likely tuberculomas, he continued to do remarkably well and was improving every day. He had not had seizures, which was one thing that we grateful for any sudden increase in intracranial pressure as is seen with a convulsive seizure could cause him to herniate given the amount of mass effect that we had seen on his original scan. Meanwhile, his family had decided to take him home given the fact that he was doing better, though unfortunately, that was only on the steroids, hypertonic saline, and acetazolamide he was receiving from us, all of which were completely temporizing, and it would take some time for the Tb meds we had him to provide some clinical response.
We brought his family member to clinic later in the day to explain them him that the boy still had a very serious problem that could easily kill him should anything worsen. At this point, we could try some other things if that happened and asked that his family agree to keep him with use for an additional five days, just to give him some more time for the meds to kick in. Their biggest concern was the money that his hospitalization was costing, and it was agreed that we would split the cost of his care. Thankfully, they agreed which gave us a few more days to watch him improve and, hopefully, continue to do so.
Since it was Saturday, there was school, and Jill had the entire day to relax. She had taken a leisurely breakfast at the Lilac Café, and I had suggested possibly heading up to Gibb’s Farm early since the rest of us would be heading up there after clinic for drinks and dinner. Luckily, the lodges in the area are all gracious to the volunteers who come to FAME as it is a very small community of ex-pats here in Northern Africa, so everybody knows everybody. I checked ahead of time with Gibb’s, and they said they would be happy to host her for the afternoon, so after lunch, we called a taxi that we were familiar with and off she went to spend the afternoon at one of the amazingly relaxing places that I have every visited.
Gibb’s Farm was originally a large coffee plantation that was later turned into a lodge after the Gibb’s family purchased the property, continuing to run the coffee farm, a dairy, vegetable gardens and also a workshop that made all the furniture for the rooms. When I had first come to Karatu in 2009, we were brought to Gibb’s for lunch after traveling back from the Serengeti and, since that time, I have continued to visit the resort every chance I have which is usually several per visit. Shortly after 2009, the resort was purchased by the owners of Thomson Safaris and the main lodge and rooms were all refurbished into what now exists today as a five-star destination resort to match anything that exists elsewhere in the world. To say that Gibb’s Farm is paradise would not be an understatement. It has remained everyone’s favorite lodge to visit here since our program was started.
With Jill safely tucked away in paradise, we proceeded to finish with our afternoon clinic and the plan to head up to Gibb’s as early as possible so that those who wished to possibly swim could do so in their infinity pool overlooking Karatu and the coffee farms that flow down the hillsides. Gibb’s is also high up on the crater rim bordering the Ngorongoro Conservation Area allowing it to offer some activities such as a hike to the elephant caves or clear to the crater rim up high. The elephant caves are actually large depressions where elephants dig up the soil to ingest some of the necessary minerals for their health. I’ve done the hike several times and it is a lovely walk through the woods that take you high up into the Conservation Area and requires you to hike with a NCA ranger who is armed in the event of an animal encounter. Hiking to the crater rim requires an entire day and an NCA guard just the same.
Finally, after everyone had been seen in clinic, everyone walked home, and it was time for us to head to Gibb’s for dinner. As we’d be heading into the Crater tomorrow, we did need to pick up some supplies such as bottled water and snacks for the drive as well as needing to fill up the vehicle since we’d be away for the entire day and it’s always best to enter a park with a full tank, water, and snacks as you never know what you might encounter. We picked up Dr. Anne on our way to town and eventually made our way up to Gibb’s Farm, which is a rather long uphill drive once off the tarmac that is typically rather rough, though with recent road improvements, is now a much more reasonably graded road, though still completely uphill.
Arriving to Gibb’s Farm is always an event when it involves guests who have never been there before. The walk from the parking lot to the main lodge is along paths of lovely flowering tropical plants including incredibly large bird-of-paradise plants that have grown far taller than any of us. The pathways wind through trickling ponds, some with lily pads and others with cat tails on which weaver birds have woven their nests. On arriving to the main lodge, the veranda overlooks the entire valley below with coffee plants as far as the eye can see and the distant hills, one in front of the other, completing the most picturesque backdrop. Having drinks on the veranda or at poolside, though, the view and the ambience are spectacular. After meeting up with Jill, we sat around the pool while both Anya and Wells choose to brave the chilly water of the infinity pool with the amazing view and the rest of us just enjoyed the quiet solitude.
We were called into the dining room shortly after 7 pm and led to our beautifully set and heavily outfitted table with more silverware than one can imagine even in the finest of restaurants in the US. Gibb’s is a farm to table restaurant with everything served having been typically grown or raised on site. The menu was a four-course affair with choices for all but the soup course along with freshly baked bread and real butter. Everyone’s dinner was, of course, absolutely amazing. Driving home after dinner, there were flashes of lightening in the distance with booms of thunder all around. The residents worked hard at making our lunches for the crater – peanut butter and jelly or honey along with hard boiled eggs, bananas and cut up watermelon. As we all went to bed, the storm intensified with more winds and nearby crashes of lightening, though we were all safe in volunteer house. It would be interesting to see what the weather would be like in the morning, though it really didn’t matter as everyone was excited for their first game drive of the trip.