Wednesday, March 15 – It’s off to “Rifty” for our first day of clinic there…

The African Massage Road

Our visits to the Rift Valley Children’s Village, affectionately known as “Rifty,” have always been one of the highlights for the residents during their time here in Tanzania. The Children’s Village, which was first opened twenty years ago by its founders, India Howell and her business partner, Peter Leon Mmassy, began with a small number of children and has now grown to include over 100 children, all of whom now call RVCV their home and India their mother. It is the furthest from an orphanage that one could ever imagine as none of these children will ever have to worry about leaving their home. Early on, it was clear to India and Peter that their children would need good medical care and it was this need that led to FAME being located where it is in Karatu, only about 45 minutes away from the village of Oldeani, the location of RVCV. Prior to the opening of FAME Medical, now FAME Hospital, Frank had been practicing in Usa River, near Arusha, honing his tropical medicine and primary care skills, and it was their becoming friends with India that let them to the Karatu district. The ex-pat community here in Northern Tanzania is very small and very tight knit.

One of the houses at the Children’s Village

In addition to having medical coverage for their children, it quickly became very clear to India and Peter that sending their children to the local school the other children from the local village, whose health was less than optimal, would become an issue. From a very early time, FAME began providing medical clinics at the village every other week that were attended not only by India’s children, but also members of the surrounding village and all the care was being provided essentially free of charge. In this manner, the general health of the surrounding village improved, and her children also became healthier being exposed to fewer illness while at school. This situation continued in this manner for several years until it seemed that many patients from outside the local village were also coming for treatment (i.e., those who were not intended to be there) and it became simpler to just send patients to FAME.

When I began bringing larger groups of residents to Tanzania, we chose to have a neurology mobile clinic at RVCV that ran side by side with the FAME medical clinics, until they stopped and since then we have continued to have the neurology mobile clinics as a stand-alone event there each visit to Tanzania. The plan this week was to spend two days at the village seeing both India’s children as well as those neurology patients from Oldeani, many of whom have been seeing us for several years. Africanus, the clinical officer who runs the dispensary at RVCV and had previously worked with me at FAME with the neurology program before having been hired for the dispensary job, contacts all the neurology patients prior to our coming, so now driving through the gates of the village, we see a great number of patients waiting to be seen by us each day.

Hussain and Mark enjoying themselves
One of my long term patients – we truly enjoying seeing each other every six months

Preparing for our mobile clinic at RVCV is essentially the same as when we do any other mobile clinic, except we don’t have to pick up lunch boxes as the kitchen there prepares a wonderful lunch for us to eat alongside their volunteers and is usually one of the highlights of a visit to the village. The drive to RVCV is a gorgeous one, albeit a bit rough and well-known for what becomes of the road in the heavy rains – essentially a slip and slide. We attended morning report as usual at 8:00 am with plans to depart for the village at 8:30. There is often a patient for us to follow up on or to see in the ward that may delay us a bit, but this morning, we were able to get a pretty good start other than having to pick Annie and the others up in town at the Mushroom Café, the best place to pick up Tanzania breakfast pastries – samosas, chapati, vitumbua (deep fried rice flour cakes), and small little bites that are like hush puppies with veggies inside.

Staffing a patient with Wells; Annie and Usha waiting in the wings

Anya and Sulle presenting a patient

Once we had everyone loaded, we were on our way towards the Ngorongoro Conservation Area gate as the turn to the road leading to RVCV is just before that. Perhaps the sign on the side of the road, “African Massage Road,” provides some clue to what’s ahead, but it doesn’t take long for anyone unfamiliar with this route to realize that they’re in for a treat. The first part of the drive is along a gorgeous ridge with plowed fields on one side and a steep hill on the other where there are scattered the homes of the local Iraqw who farm here. Eventually, though, we reach a point where, after a sharp right turn, we begin our descent to the bottom of the valley before ascending to another ridgetop. The second descent is even more fun and once we cross a tiny bridge over a small stream, we make a sharp hairpin to the left and quickly ascend to the top of the ridge, through acres of coffee plants and finally arrive to our destination, Rift Valley Children’s Village.

Our pharmacy

Wells and Mudy hard at work

The road today was very decent and even though there had been some rain in the recent days, there were no issues. A year ago, we had traveled to the village in the midst of heavy rains, requiring the use of four-wheel drive low for most of the journey, not so much for traction, but more to prevent hitting your brakes on the downhill portions of the road as doing so is at your own risk and typically leads to an uncontrolled slide. This is all a bit nerve wracking considering that the majority of this road on a hillside with a steep drop off being present on one for much of the way. Today’s drive was much more uneventful, and we make it to the village in no time to begin our clinic.

Hussain and Mark presenting a patient

As I mentioned, driving through the gates, we’re immediately met with the sight of dozens of patients sitting on benches waiting to see us and, had it not been for the steady rain that began shortly after we arrived, they would have all been sitting there for much of the day while we worked through the high stack of paper charts. Instead, when the rains began, they moved all the patients into the nearby gym where they could all be registered and wait for us in a more suitable environment. By the end of the day, I think we had seen about 35 patients in total with many, many epilepsy patients, but also quite a few patients who had neurologic complaints that we were unable to attribute to anything and either had to consider treating them symptomatically or not at all. There was little that we had to investigate further, though if someone needed labs or a CT scan, we could always send them to FAME on another day to obtain the necessary studies.

Joel, Angel, and Brigette going over medications

Annie and Usha worked together seeing the pediatric cases in one of the examination rooms that has animals painted on the walls and has always been used for this purpose specifically. There were quite a few pediatric cases, so they were kept busy while Anya, Mark, and Wells each worked with one of the other translators seeing either adults or an occasional child if the pediatric room became a bit busy. Both charts and prescriptions are all handwritten and, at the end of the day, the notes are all copied so that we have a full set of the notes for our binders at FAME. Joel, a nurse who has worked with us many times served as our pharmacist, both dispensing medications as well as giving patients detailed instructions and information that also included the need to remain on the medication, especially for patient with epilepsy, as chronic disease is not a concept that many patients are familiar with here. Infections, such as malaria and worms are well understood and require only a course of medication that is then discontinued. Not so for epilepsy medications, which must be taken long term and consistently, if not indefinitely.

As I mentioned, the highlight of the day, at least for those of us who live to eat, rather than vice versa, is lunchtime. The number of people working at RVCV has grown over the years, volunteers, and staff alike, and all eat together in the kitchen building where a wonderfully delicious meal is prepared daily by the kitchen staff and consists of all fresh ingredients, usually a main course, salad, and fresh fruit. Though I love the rice, beans, and mchicha that is served five days a week at FAME, I will have to admit that the lunch at RVCV is a welcome change for us. Today, the main course was open face ham and cheese sandwiches on freshly baked bread. Needless to say, it was well received by all.

Saidi, Africanus and Ema

After lunch, the residents were taken on a tour of the village and a visit to the duka (store) for the Rift Valley Women’s Group, another facet of the Tanzanian Children’s Fund, the non-profit that funds not only the RVCV and the Women’s Group, but also their education efforts in the area that I’ll discuss more in tomorrow’s blog, for during lunch, Arturo, now the CFO of TCF described at length with us during lunch.

For now, it was just a matter of finishing up with all the patients that had come today to be seen by us. We are typically shooting for a return to FAME around 5 pm, but today we were still seeing patients late into the afternoon and well past 5 pm. Thankfully, it hadn’t rained during the day, so the drive home would most likely be uneventful for any trip one takes here always has the possibility of being more of an adventure than one had bargained for.

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