Wednesday, September 27 – Day one of Rift Valley Children’s Village…

Charlie, who is either guarding the Lilac Café or hoping for a handout (most likely the latter)

It was not an accident or unintentional that FAME came to be in Karatu. Rift Valley Children’s Village and the Tanzanian Children’s Fund, TCF, is an institution that was founded some 20 years ago by a remarkable individual, India Howell, who, like many of the ex-pats living here now, came to Tanzania originally for travel and fell in love with the country. Recognizing the need to provide for those children who had been orphaned, or whose families were unable to care for them, she created the Children’s Village, along with her business partner, Peter Mmassy, and then proceeded to adopt her children rather than having them remain as orphans. From that humble beginning, TCF has now become a multifaceted organization that is not only home to over 100 children who are a family, but it also has partnered with the local education system to provide better and safer schools, has empowered women in their region to develop and maintain businesses which they help promote, and has provided for the health of the local population.

Scenes along our ride to Rift Valley Children’s Village

It is that latter function that has involved FAME since it’s creation. The Children’s Village is in the district of Oldeani, an interesting village that has a unique history that is for another blog, that is only 45 minutes away from Karatu and is the reason that FAME exists where it is. When Frank and Susan were researching a location for their dream of creating a health facility, it was Mama India who suggested coming to Karatu, for, in addition to its close proximity to Oldeani and the Children’s Village, Karatu sits on the main, and technically only, road to Ngorongoro Crater, the Conservation Area, and the Serengeti, meaning that every safari vehicle and every tourist has to pass through this town. Though FAME’s mission is to improve the health of the Tanzanian residents of the Karatu district, it has also become the main health facility for any tourist traveling the Northern Safari Circuit, certainly improving the exposure of FAME as a non-profit, charity hospital to greater funding opportunities.

Jenna and Whitney arriving at Rift Valley Children’s Village
Africanus giving us a tour of the new health facility at Rift Valley Children’s Village

FAME has always provided the care for Mama India’s children, initially with medical clinics held onsite for the children and the Oldeani villagers, though over the last five years or so, patients are now brought to FAME for their treatment, which has proven to be more efficient and economical. When I started doing mobile clinics back in 2011, though, and especially when I began bringing residents in 2013, it was decided that we would run a separate neurology mobile clinic there at the same time and have continued to do so even after the FAME clinic there was discontinued. We now provide two full days of mobile clinic twice a year at the village, seeing both India’s children as well as the residents from Oldeani with neurologic disorders. Outside of these two clinics, though, patients continue to come see us at FAME as there are cars coming from the Children’s Village continuously throughout the day so that accessibility is not an issue.

Africanus and Nuru chatting before clinic starts

Early on, Rift Valley Children’s Village employed a nurse practitioner to staff the medical dispensary at the village for both their children and the Oldeani residents. I’m fairly certain that all the nurses were from the US, that is until several years ago when they hired Africanus John, a clinical officer who had volunteered at FAME and had worked with our neurology clinic as a translator initially and was then hired by FAME as a clinical officer. When the Children’s Village needed a new medical officer, they hired Africanus, with FAME’s blessing, of course, and I could not think of a more qualified or perfect person for the job. Not only is he a great clinician, having taught him neurology and then worked with him when he was a clinical officer for FAME, he is an amazing administrator, having now fully organized the dispensary so that it is operating smoothly. Africanus frequently contacts me in the US when he has questions about our patients in between visits and occasionally about new neurology patients that have come his way. Having Africanus there to help manage our patients has made our job tremendously easier than in the past and we look forward to having him around for as long as possible.

Angel, Veronica, and Joel in our pharmacy
Wajiha walking a patient to the examination room

Today we were heading to the Children’s Village for the first of two days of our fall neurology clinic there. I hadn’t mentioned before, but I now have the use of two Land Rovers, one stretch (i.e., a safari vehicle) and the other a stock version of the Land Rover Defender 110. In the past for our mobile clinics, given the number of residents and interpreters we have, I’ve had to rent a safari vehicle from the Kudu Lodge to use alongside my stretch Land Rover as we could not all fit in one vehicle and there were no spare vehicles at FAME. We can all fit in our two Land Rovers now including our medications and other supplies that are necessary for the day of seeing patients. Though our plan had been to depart at 8:30 am, one always must remember that this is Africa (or TIA as Frank always reminds me) and time moves at a much different pace than we are used to back home. There are a lot of moving pieces involved that includes coordinating the two vehicles and the fact that half of our neurology group (mainly our interpreters) live downtown and, therefore, have little need to travel all the way up to FAME when only be passing by the junction with the main road on our way. And a stop at the junction to pick up people usually involves a visit to Mushrooms Café, one of the local hangouts for a quick Tanzanian breakfast or to grab good take-out goodies for the road.

The doctor’s view
LJ with Amos and Nuru

This morning, I also had to make a deposit to the bank for our upcoming trip to the Serengeti and the bank opened at 8:30 am, which was perfect timing as I thought I could get in early and take care of the transaction quickly. I asked one of the bank employees which line I should stand in and he asked me if I had filled out a deposit slip or not, which I hadn’t. He pointed out the slip I needed to fill out and I asked him specifically how to list the actual bills as they had shillings on the form rather than US dollars, though he said that was perfectly fine. I waited in the line he said I should use and, when I arrived at the teller, of course she told me that I hadn’t filled out the right form. A bit frustrated and in a hurry, I just stood there and told her that I filled out the form I was told to fill out and didn’t show any interest in stepping out of line to get the correct form off the counter, if it was even there. Eventually, she excused herself for a moment to retrieve the correct form for USD and I filled out the correct form after she returned while I still stood at the window. Having eventually taken care of the deposit, I left the bank, hoped back in the vehicle, and we were off for the junction, and Mushrooms Café, where we had planned to meet.

Our pediatric room with Whitney and Dorcas
Fien and Nuru evaluating a patient together

By the time we had gathered everyone together and seating was finally sorted out as to who was going to ride in which vehicle (we had our four translators squished into my back seat, so we were now 10 in Turtle), it was after 9 am and we were finally under way to the Rift Valley Children’s Village, a drive of about 45 minutes or so. Leaving Karatu behind us, we headed in the direction of the Conservation Area gate, though left the tarmac just short of it on a road marked, “Crater Forest Tented Camp, African Massage Road,” giving one a bit of a hint as to what the drive ahead is like. Though the remainder of the drive to the village isn’t the roughest of roads, it is somewhat bumpy as I’m sure the residents who have been before and those with me now will without doubt attest. Thankfully, it is also a gorgeous drive along a ridge between plowed fields of grain that are now golden post-harvest. The farmer’s homes are typically just off the road on the downhill side looking down into a lovely valley with more golden terraced fiends until we reach the end of the ridge and need to descend a somewhat steep path leading to the bottom. In addition to the natural bumps in the road, there are carved drainage ditches that angle across the road at varying frequency, dug there to direct the heavy rains off the roadway when they come.

Our lunchtime

I have driven this road in all weather, including heavy downpours, and it is very treacherous, making me thankful for my four-wheel drive as well my low range on the transfer case. Driving down the steep inclines in the mud requires the willpower not to touch your brakes, for doing so will undoubtedly put you into an immediately slide. The low range on the transfer case allows you to use the engine to brake the vehicle and to maintain the correct direction of the vehicle. I the heaviest of downpours, I’ve used the alternate road through Oldeani going home as these roads become nearly impassable, yet the staff village drivers will do this multiple times a day fearlessly. The Land Rover is absolutely the vehicle of choice for these roads given its wider stance and lower center of gravity, along with its fulltime four-wheel drive compared to the Land Cruiser. The Land Rover is nearly impossible to get stuck, though I have done it once a number of years ago and learned my lesson.

Jenna and Hussein evaluating a patient together

The final incline up to the village, and the coffee plantation that surrounds it, is even extra bumpy just to remind everyone that we are in Africa and in the bush. We reach the gate of the village after passing by the primary school that is adjacent and the abandoned coffee pickers village (the workers were moved to other housing, though there are still a few squatters living there) and arrive to the gate. Passing through the gate, one enters what can truly be described as Shangri-La, for it is another world all together with all the children playing and their houses where they live, for this is their home and not an orphanage. The village is home to over one hundred total children, most of who live inside the village itself, while the older children attending college or returning home to visit have houses just outside, but still part of the compound. Each of the houses for the younger children, divided now by sex and age, has a house mama to provide their daily care and upbringing. Children going to primary school access the school next door, while most the older children attend one of the secondary schools in Oldeani before eventually leaving for college. Regardless, Rift Valley Children’s Village remains their home forever and Mama India their mother.

Veronica and Joel
LJ and Amos examining a patient

Our clinic space at the village has for years been the dispensary office that is attached to all the administrative offices, but on arriving, Africanus led us to their brand-new health facility that was recently built to house his office, a number of exam rooms, a minor procedure room, a pharmacy room, and a laboratory room. The center is located just outside the village now and is attached to the duka, or store, where the Rift Valley Women’s Group merchandise is sold, which is always one of the highlights of a visit here. It is also closer to where the older children’s homes are and has plenty of room for patients to sit out in front while waiting to be seen. Africanus has triaged all the patients and we have written charts already pulled for patients who have been seen by us before and sheets of paper to write on for those who have not. Writing notes is a new thing for the residents and only done in the mobile clinics as FAME’s EMR is on the intranet and not available off the FAME campus. Charts are also divided into two stacks – children and adults – and the number of children here is typically higher than we see at FAME making Whitney quite happy. We had four examination rooms set up, and at some point, the residents decided to have five rooms with Fien there to help, making my job a bit more hectic with five residents to staff. Thankfully, it isn’t required for me to see the patients here myself as that is mainly a Medicare requirement at home. Should there be a question about the patient, or an exam finding in question, I’ll join them, but given the excellent residents I’m working with, that’s rarely a question, and when there is one, it’s appropriate.

Mama India’s dog, Longshot, taking a rest

Lunchtime here is a bit earlier than at FAME and lunch is served to us in the volunteer kitchen where a fresh lunch is made every day for the volunteers. Though I can’t say enough good things about the lunches we eat at FAME, especially the rice and beans, that are made for the entire staff, volunteers and Tanzanians alike, I’ll have to admit that the lunches at the village are particularly good and a bit more home like. Everything is grown there, and the salads are delicious. We had a wonderful chicken salad with freshly made bread, couscous, coleslaw, and fresh fruit. What more can I say?

Elibarki and Wajiha evaluating a patient

The residents had hoped to visit the duka today, but clinic went on for longer than expected and we didn’t end up getting out until after 5 pm. Unfortunately, the person who runs the duka had left for the day, so it was an activity that would have to be done tomorrow when we would be back for day two of the clinic. One the way home, by a slightly different and even more beautiful route, the residents decided to go out with the translators, all of whom had recommended a new location (rather than the Golden Sparrow which is a dance club) that is a mobile bar fashioned out of an old safari camp supply truck. The “Dunga” was created by Nixon, who has played a large role at FAME and owns and runs the Lilac cafés, is pretty much like a food truck that is equipped with a bar as well as the ability to cook food.

The Dunga at night

Later in the evening, we drove into town, where we picked up the translators and then drove in the direction of Rhotia. Just before the incline, there was an old, abandoned structure that was primarily some walls and piles of sand, and I was told to turn in there. As we got closer, sure enough, there was the dunga, parked inside the walls with chairs set out and a bonfire in the middle. Denis, an old friend and artist, was manning the dunga, which was very reassuring to me as I was planning to drop everyone off and head home and the whole thing was just a little bit sketchy to me. In the end, they had a wonderful time and I drove back later that night to pick everyone up as Wajiha had texted me that they were all going to take bijajis home, which I didn’t think was safe that late at night. My only requirement is that they all are able to get up for clinic the next morning, and they were, so all was good.

Out at the Dunga

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