Wishing to accommodate the American Neurological Association’s national meeting that was being held in Philadelphia this year, we’re departing two weeks behind our normal schedule, though for a worthy cause as it was important for us to allow as many residents as possible who wished to attend this important national meeting. This was made even more significant given the fact that our chair at Penn, Dr. Frances Jensen, who has been a strong supporter of our global health efforts since my arrival to Penn in 2013, is the outgoing president of the ANA this year. Be that as it may, the scheduling worked out the same and we will still be able spend the requisite six weeks on the ground there with two groups of residents, each spending three weeks.
I’m also very grateful that on this trip I will have a peds neurology resident for both sessions as it is always so very necessary for us to have them here given that we probably 1/3 of the patients we see on average are children and, though I do like to care for children and have done so for most of my career, I am not trained as a pediatric neurologist nor would I ever consider myself as capable.
The first group of neurologists this trip will be Lindsay Agostinelli, or LJ as she likes to be called, Jenna Miller, and Wajiha Yousuf, each adult neurology residents, and Whitney Fitts, our pediatric neurology resident who is from CHOP, or Children’s Hospital of Philadelphia, one of the top children’s hospitals in the world. Though each of the residents have yet to specialize, they each have their own interests and have likely already decided which of the subspecialties they will pursue for fellowship. Next week, we will be having a neurology resident joining us from somewhere else other than Philadelphia for the very first time. Fien Oelbrandt, who is a currently a senior neurology resident in Belgium and who has already done volunteer work in Africa, including Tanzania, somehow came across an old neurology podcast concerning our work here at FAME. After a few emails and a Zoom session, it was clear to me that she would fit in with the work we do here as well as have a great experience, though perhaps even more importantly for me, I was very excited to have my residents exposed to someone who had come from a completely different system of medical education and practice. It is through these chance opportunities and sharing of knowledge that we often find the greatest experiences and that cannot be more true than in the world of global health. For it is through the bilateral sharing of information with others around the world that we can most effectively create change and better the lives of those less fortunate.
As is usually the case, our trip began at the Philadelphia Airport and the Qatar Airways ticketing counter. This is always one of the most stressful points in the journey for me as I am usually carrying far more in my luggage than just my person items and my baggage always approaches, or exceeds, the weight limits for the trip. Truthfully, I have enough clothing that I’ve accumulated here at FAME over the years, that I could probably show up with nothing and do just fine for the entire six weeks. For this visit, I am bringing an automatic refractometer that was donated to FAME and has nothing to do with our neurological care, but rather is something that Sehewa, our default eye doctor here and who is also an incredibly experienced nurse anesthetist. The piece of equipment weighs a whopping 50 pounds without a container, so when all packaged in the nice Pelican hard case I just happened to have, it topped out at exactly 70 lbs., which just happens to be the maximum weight to send on the airline, of course with a fee of $75 for being overweight.
The neurology clinic at Penn also happened to have a very large number of supplies that were approaching their expiration dates and needed to be disposed of. Syringes (yes, they too have expiration dates), injectable medications such as lidocaine and Depo-Medrol, which we use for our occipital nerve blocks, special wound dressings, injectable sumatriptan for acute migraines, and much more that would surely be of good use here at FAME. Combined with several medications that I was bringing (mainly levetiracetam, and antiseizure medication we use here and which is very expensive to obtain here, but not so by using GoodRx in the US) and special orders for others (chew bones for Oscar, doggie nail clippers, and a huge kitty litter scoop for Elvis, Frank and Susan’s Sokoke cat), my second duffel just weighed in at the maximum limit of 50 lbs.
My personal duffel (I am technically allowed three 50 lbs. duffels as I am now a gold member with Qatar following my trip to Viet Nam last November) contained my large photo backpack, (which is far too large to carry on) that probably weighs about 40 lbs., and then the rest of my personal belongings. My two carry-on items are my canvas photo bag, containing my main camera and two long lenses, and a small duffel with my computer, meds, headphones, and such. These two items are over the limit for on and there is usually a back-and-forth discussion between me and the counter agent. I think I’m still ahead in this twice annual jousting session, though the anticipation of this encounter continues to create anxiety as I approach the airport. Once through, which on this occasion was successful, I can relax until I reach Kilimanjaro and customs.
Wajiha, who is Qatari, had left the day earlier as she was planning to visit with her family and husband and would then meet us in Doha for our departure to Kilimanjaro. Having arrived at the airport at the same time as Jenna and LJ, we went through check in together and then headed over to the American Express Centurion lounge for some food and drink prior to our first flight. Whitney met us at the gate, as did Malya, who was with me in Tanzania last April and just happened to be on our flight as she was flying to Zambia for a month-long rotation with Deana Saylor, a wonderful neurologist from Johns Hopkins who has built a much-needed residency program there over the last several years.
Our flight to Doha, Qatar, was long (just over 12 hours) but uneventful and we arrived there just a bit before 5 pm. It is my normal practice to go to one of the several amazing airport lounges in Doha as the layover here is just a bit over 8 hours and they have plenty of food, coffee, and showers available to keep me awake and productive. With the layover just over 8 hours, though, the airline was offering a free hotel room so that both Jenna and LJ decided it was worth the adventure even though I had told everyone that I had four lounge passes for guests. Whitney, on the other hand, saw the wisdom in my offer and followed shortly after me to the lounge with all its amenities. Malya, whose final destination was Zambia, but would be in Doha for the same amount of time as us, had initially booked a sleeping pod at the airport, but was able to rebook that for her return flights and shortly followed us to the lounge. Having let Whitney into the lounge earlier with one of the free passes, I once again walked back out to the front desk to arrange for Malya’s entry to the lounge with another one of the free passes. They each took full advantage of the food and showers, as did I, and the three of us spent some nice relaxing hours in the lounge as it was fairly quiet throughout the evening.
Having adventured out of the airport to one of the hotels they had been assigned to, Jenna and LJ were apparently split up on the shuttle with Jenna being told that she should take a 10 pm shuttle back for our upcoming flight that was not scheduled for departure until 1:45 am! Once again, I walked back out and secured entry for Jenna into our lounge so that she could join us. Sometime after, though, LJ suddenly appeared in the lounge as for some reason her texts had not been going through, so she wasn’t able to reach me and ask for my assistance with her entry. Thankfully, she was either let in or she barged by the front desk people, but either way, she was now here, and I was able to use my final pass for her. We promptly toasted our travels with glasses of Champaign from the bar and enjoyed the few remaining minutes that we had prior to needing to depart for our gate. I still had to pick up some perfumes that Pendo had asked for from the duty-free shop, but knew that wouldn’t take long at all, so left the lounge a bit before the others and would meet them at the gate.
Our flight from Doha to Kilimanjaro was entirely uneventful. Thankfully, LJ’s visa had been approved the day before our departure, as that would have caused a huge delay in our processing through the airport. Imagine a jumbo jet full of tourists arriving to an airport only a fraction of the size of any other international airports and then expecting everyone to get through in a reasonable amount of time. With visas now being done online (as long as you get it to them on time, – LJ), getting through immigration is a good deal quicker these days, but there is still the issue of getting through customs, which, depending on what you are carrying, can be either a very simple matter, or much more complex of an issue. Today’s visit with customs was somewhere in between those two options and related entirely to the donated refractometer that I was traveling with. I had all the proper papers for bringing the medical device into the country as these had been sent to me by FAME but was unfortunately lacking the necessary information and letter to have it come in duty free as a piece of donated equipment. After much discussion and a phone call to Susan (our executive director), it was finally determined that we were OK bringing it in without paying anything, though I was given the necessary information required for the next time I try to bring a piece of donated equipment.
Once out of the airport (actually, I had brought everyone out earlier to meet up with Leonard in the midst of my negotiations with customs), we were able to load all our luggage into Myrtle (my short Land Rover) and a van that had been loaned by my old friend, Vitalis. I rode in the van, while the four residents rode in Myrtle along with Leonard on the way to his house for breakfast before continuing our journey to FAME. For the ride here, Wajiha slept in the back most of the way, though did awaken when we got to the Lake Manyara overlook. It was a very dry and dusty trip and even though we were on the tarmac, dust filled the air and gave an overcast gloom despite the clear skies and intense sun that beat down upon us. We arrived at FAME shortly after 3 pm, fairly early for us, and were all exhausted. We rolled out of bed briefly to take showers and head downtown to the Lilac Café, but upon our return, it was pretty much lights out for everyone. Tomorrow would be an orientation in the morning for the others and then we’d begin clinic in the late morning.
