Our very first neurology mobile clinic occurred in 2011 and was in Kambi ya Simba, where we’ll be heading today. I never would have imagined on that very first clinic that I would still be traveling to the same village after a dozen years, yet here I am. What was a tiny dispensary back when we started visiting this village has now turned into a health center that was actually visited by the President of the country several years ago and is one of the health ministry’s flagship centers.
Kambi ya Simba, literally meaning Lion’s Camp, is in the Mbulumbulu region of the Karatu District and sits along the escarpment of the Great Rift Valley just northeast of the village of Rhotia that is on the main highway to the Serengeti. This is a highly volcanic region (Ol Doinyo Lengai, a nearby volcano, last erupted in 2008) and, as such, is incredibly fertile and the entire area surround Kambi ya Simba is made of fields of crops that are grown by the Iraqw, who settled in the area. As you travel further north along the escarpment, towards the village of Upper Kitete, where we used to have another clinic, the area between the mountains to the west and the drop off into the Rift Valley becomes narrower and narrower until you finally reach the 2000-foot drop into the valley below. I have posted many photos of our visits to the overlook which is one of most amazing views up and down the Rift Valley.
I was also contacted several years ago by someone who had run across this blog and had been volunteering in this region back in the 1970s, just after independence, and sent me lots of photos that he had taken back when the new government was active here with their socialist plans for work camps and such. One of these camps still stands as a memorial just outside of Upper Kitete and is a reminder to the roots of a brand-new country that only came into existence in 1964 with the merger of Tanganyika and Zanzibar (Tanganyika had gained independence from the British in 1961).
As it was Tuesday morning, our education lecture today was given by Dr. Judith, who is a volunteer surgeon working here for a bit and helping with our surgical program. Her talk was on peritonitis, something that we don’t deal with on a regular basis in neurology, but she covered the basics and, as would be expected given how far I am from my basic medical training, I did learn a few things during her half hour talk. A rather brief morning report followed her talk which allowed us to get prepared for our mobile clinic a few minutes early, and it wasn’t long before we had the stretch Land Rover filled with neurologists (there were probably more neurologists in our vehicle than there may be in the rest of the country!) and on our way into town to meet up with the other vehicle that was transporting our translators, social worker and nurse to dispense medications.
To reach Kambi ya Simba and the Mbulumbulu region, we head east out of Karatu and up the big hill towards Rhotia. This steep hill was the site of a horrible school bus accident back in 2017, in which over 30 children died when their bus lost control heading down the hill and fell into a ravine after leaving the road. Once in Rhotia, we leave the tarmac and head northeast past beautiful farms and small enclaves of houses. Some of the fields are tilled by hand and others are lucky enough to have a tractor to do the work. One the way home in the late afternoon or early evening, we typically pass large groups of school children, all dressed the same in their individual school uniforms that is a standard practice throughout the country. There are lots of vehicles coming and going along this road, some being larger buses on a schedule, and others that are older Land Rovers completely packed inside and out with as many bodies as possible and then some. Their tops are stacked with more supplies than one could ever imagine and then there are usually several individuals sitting on top plus one hanging off the back. With their high center of gravity, they sway from side to side so that I’m always very careful when they pass for fear they might lose control.
Once we reach the village of Kambi ya Simba, it is a short drive uphill and out of town to reach their health center and three are usually lots of patients waiting for us on the benches outside the rooms we use as interview rooms. Today, though, there were fewer patients than normal, and we later found out that it was market day for the village which means that many of our patients were very likely attending the market as this is very often a vital part of people’s lives here for it can be their main source of commerce and, occasionally, income. It did turn out, though, that our clinic also coincided with their RCH clinic meaning that there were lots of mamas with their little babies, each with their own little harnesses for weighing them on the grocery scale as it is done all over. This is a tradition here and something that is done at all the villages and even in the RCH clinic at FAME.
The health center at Kambi ya Simba consists of many buildings, a far cry from what it was when I first came here and held the clinic outside in front of their wood and stick church building. There is still a very rustic feel, though, and the several chickens running around in the courtyard grass certainly would attest to that fact. Even more so, though, was the incredibly loud and large rooster keeping watch over his many hens. If there was anyone to “rule the roost,” he looked the part.
Our clinic was in one of the outbuildings where we were able to find four rooms to use, though one of them had an outer door that was missing its handle and hasn’t opened in several years. Thankfully, the room on the other side of the stuck door was fully accessible from another one of our rooms, so other than the fact that you had to escort your patient through a room in use, it worked quite well. Their RCH clinic was in the same building, so all the babies seeing the nurse for their well-baby visits were there for us to gawk at and pour over.
With the fewer number of patients present due to it being market day, everyone was able to take a bit of a breather and things were less rushed for us. There were the typical number of new and follow up patients for us to see with the more common diagnoses that we see here such as epilepsy, headache, neck and back pain, and neuropathy. We don’t have access to labs here, so if patients require them, they are sent to FAME to have them done. The other issue we have is that we only come here every six months which can be a long time for a follow up visit, especially if the medications require either a titration or an assessment as to whether to adjust or discontinue.
We had brought box lunches with us from the Golden Sparrow, though had forgotten to tell Kitashu that we had two vegetarians with us. There was a reasonable amount of food in each box that was still edible for them, so it was not a huge catastrophe. Whenever we’re on mobile clinic and at one of the villages, we never eat in front of our patients or the workers as it is quite possible, and very likely for that matter, that they have a significant food insecurity and may not have had a meal for some time, so instead, we eat in the car most of the time or find an out of the way place somewhere in the shade to eat. Kitashu will most often also hand out any extra food from the lunch boxes or extra drinks to the local children or others from the village. I remember years ago, attending a soccer match with Leonard that was high up on the slopes of Mt. Meru outside of Arusha, where the soccer teams supplied all the ingredients for a massive pot of rice, vegetables and chicken that was distributed to all the villagers. Everyone was so happy and joyous that they were having a full meal as that is not often the case. In a similar manner, I am always amazed at the amount of food that many of the FAME employees take for the communal lunch that is served there. It makes perfect sense, though, if you realize that it may be the only complete meal they are receiving for the entire day.
We finally finished with clinic at Kambi ya Simba and were heading back to Karatu well before sunset which a nice turn as we’re often coming back from mobile clinic late. Last spring, we came back from the Lake Eyasi region clinics well after sunset which is always an issue as driving at night here is not something that’s advisable for a few reasons. First is probably the fact that there are lots of wild animals here that often like to cross the road at night. Secondly, drivers here are not the best. The large buses often drive far too fast to keep on schedule and will frequently crash on their own or would happily involve another vehicle in their mishaps. Vehicles commonly pass in no passing stretches where the visibility is already terrible during the day and is far worse at night. There are no streetlights here, and when the sun goes down, it becomes incredibly dark.
Today, though, we were getting into town early enough for me to drop off the group in the business district of Karatu with our interpreters who could guide them around to see what they wanted. Karatu is a frontier town that exists because of the safari circuit and is the last outpost of civilization on the road to the Serengeti. It is the jumping off point for most trips and there are almost more safari vehicles here than there are people. In the evening time, all the guides are out washing their vehicles and staying in town at the “guesties,” or the inexpensive guest houses while their guests are staying in the more expensive lodges, waiting to be picked up in the morning in a clean and shiny vehicle, only to do it all over again given how dusty it is here right now.
I left the group off by the Bamprass fuel station in the center of town and was quite comfortable with them walking around town with their escorts. Other than the street vendors trying to see their wares, there was little trouble they could get into here. Karatu has changed, though, over the years. When I first arrived, the only paved road was the one that went through the center of town and there were no buildings over three stories, or maybe even two. Now there are several five plus story hotels in town and there have been paving roads in town so that there are now several of them. Six months ago, I was shocked to see streetlights through the center of town and even though it makes a difference as you drive at night so that instead of seeing dark shadows running across the street in front of you, you actually can see things. Regardless, I do long for the old wild west days of Karatu but am aware that change is inevitable.