From the very beginning of my time in Tanzania, I have been involved in mobile clinics to the smaller communities of the Karatu district. The first mobile clinic that I participated in was a very large, campaign-style effort that involved a large portion of the FAME staff traveling to the remote regions of Lake Eyasi and providing a weeklong clinic in several of the communities there. These clinics served primarily the Datoga and the Hadza tribes, both tribes living in this region and the latter tribe representing the last hunter gatherers living in Tanzania. The Hadza are the bushmen of Tanzania and one of the click language speaking cultures of the world, incorporating different click sounds representing consonants into their normal speech. They are a very unique tribe in Tanzania and, unfortunately, are decreasing in numbers due to loss of their game because of outside pressures placed on the land by other tribes such as the Datoga who graze their livestock on land previously used only by the Hadza. At approximately 1500 individuals and declining, it is unclear how long they will continue to exist. Here.
Our trips to Lake Eyasi were always a monumental experience for a number of reasons. We represented a very big crew of individuals that included not only caregivers, but all the support staff necessary to travel into a remote region where there were no facilities other than the shells of brick buildings for us to sleep in and use for our makeshift exam rooms and for our mobile lab (blood smears, malaria, syphilis, brucella, etc). We often set up shop in dirt floored, brick schoolrooms that could house several clinical teams each. We would eat our meals as a group and the same cook, Samwell, who continues to serve meals today at FAME, cooked our meals on these trips, along with a Paula Gremley, an American social worker by training who had her own non-profit for helping out in Tanzania and traveled with us on these clinics.
It was Paula who first brought up the idea of our traveling to the local villages on the outskirts of the Karatu district to provide neurological care to these residents, not only because they could not get to FAME, but also since they more often didn’t realize that they had an illness that we could treat and improve their quality of life. My very first mobile clinic was to the village of Kambi ya Simba (or Lion’s camp) where we had no facility to use and instead placed several desks out in front of their church and began seeing patients. Our nurse, Patricia (who still works at FAME) came along with a large storage box of medications that served as our pharmacy. Kambi ya Simba was in the Mbulumbulu region of Tanzania, a very fertile land that has been settled by the Iraqw tribe who farms throughout the area and is quite the polar opposite of the Maasai when it comes to their livelihood. Quite simply, the Maasai are pastoralists whereas the Iraqw are farmers, and their culture is solely based on agriculture, growing numerous crops on the land they tend and plow.
We would also travel out to Upper Kitete, another village in the Mbulumbulu region that was populated by the Iraqw and was even more remote than Kambi ya Simba. Upper Kitete also has the unique distinction of being one of several sites where an attempt was made to establish socialist camps, or government farms, following their independence in the 1960s when Julius Nyerere, the first president and father of the country, began to plan for the future of the country and which direction they would head. The socialist camps were never successful, and the country is a now presidential democratic republic, but the camp in Upper Kitete remains as an historical monument to their past experiences in developing the country that exists today. Several years ago, I was contacted by someone who had found my website while searching the internet for he had spent several years in Upper Kitete with the Peace Corps back in the late 1960s and had fond memories of the place. He still had some photos, in both black and white as well as color, of the village and life as it was there shortly after independence. One of them pictured local villagers posing with elephant tusks and was a chilling reminder to the one of the many dark pasts that exist here in Africa.
It’s always exciting traveling with the team for mobile clinic given the group effort that occurs to put it together. Doing so would never be possible without the help of our outreach coordinators, Kitashu and Angel, both incredibly experienced at organizing these types of efforts and also fully in tune with the needs of the patients we see as they are also both incredibly competent social workers. I have worked with each of them for several years now and have come to rely on them completely for the success of our clinics, both at FAME as well as our mobile clinics. Preparing everything necessary for a day in the field requires skill to make sure we have everything needed for traveling well over an hour on dusty and bumpy roads only to find out that we forgot something is not a happy feeling. Our medication box must be stocked with all the possible medications we might use for the trip, though in a pinch, we have sent medications later by bus for the patients to receive them.
Our team consists of either Kitashu or Angel, a nurse to dispense medications, four FAME translators/clinicians, an extra driver (I typically drive Turtle), myself and the residents. Often accompanying us will also be the volunteer coordinator here at FAME who make be documenting the trip and taking photos. We will typically bring the lunchboxes that are similar to those supplied on game drives along with lots of water and some snacks. Depending on the volume of the clinic, our drive home can be in the dark, though we do our very best to avoid this as driving the back roads, or even the main ones, can be very treacherous in the dark and is best to be avoided at all costs. And, of course, there are always the inevitable breakdowns that will occur when driving vehicles that are subjected to the conditions that exist here day in and day out.
The old dispensary at Kambi ya Simba was promoted into a full-fledged health center a couple of years ago following a visit by the former president and lots of fanfare. Driving up the day after his visit, we wondered if all the flowers and signage was for us, but alas, it was not. No matter, though, it still made us feel special just to see all the brightness and hope. What did not exist when I first came is now a complex of at least a dozen buildings including several wards and maternity. The center is managed by a clinical officer, as are most in Tanzania, along with a nurse. On occasion, our clinic coincides with their well-baby day when all the local mothers bring their young children to be seen by the nurse. This includes them being weighed which takes place using a meat scale hanging from the ceiling with each baby using their own brightly colored harness made by their own mother or grandmother (Bebe). Despite the crying babies, it is a joy to witness as each mother is so proud and happy when their baby is being weighed and deemed healthy by the nurse. I have always admired this sense of community that exists here for the support systems that exist for these mothers is something very special, indeed.
Our patient load here typically varies quite a bit and may be related to the time of year and whether it is harvest season or not. When it comes to tending their crops, there is little else that takes precedence, including their healthcare, for without this gift from their land, there is no life, and the family will fail. For the Iraqw, their crops are their existence, and their existence is their crops. It is not seen as a struggle, it just is. And it just is as it has been for several hundred years since their coming to Tanzania from the north.
Our clinic proceeded without a hitch, and though the numbers of patients were perhaps less than we had hoped for, it was still a steady pace and kept everyone busy for the day. Our lunch break, which is taken back at the vehicles so as not to eat our lunchboxes in front of those who may at times not have enough food, was relaxing, though the sun was hot. On my first visit here back in 2011, our group was small, and we were provided a more traditional meal of pot roasted chicken, ugali and vegetables that the village mamas had cooked for us. I remember that day very well, for it was the first of my neuro mobile clinics here that now number close to 100, or possibly even more. It was such an honor to have been served our meal as we were, though I have since come to understand that providing a meal or food to someone visiting is not something that is taken lightly and, perhaps even more importantly, the honor is not for the guest, but for the host.
With our clinic finished for the day, everything was packed again into the vehicles, and we began our drive back home along some of the most incredibly picturesque scenery that one could ever imagine. The fields were lush and gorgeous and full of crops ready for harvest before the oncoming rains of late April and May. These are, without question, the loveliest people on earth, and we are the luckiest people on earth to be here with them.
One thought on “Monday, March 13 – It’s neurology mobile clinic week and first up is Kambi ya Simba…”
Thank you Dr. Rubenstein for showing me your blog. The stories and pictures are wonderful and beautiful.