[Note: As these blogs are written several days after the fact, I wanted to make sure that Caroline’s family was aware that both she and Dennis arrived safely on Sunday morning and are now at FAME ready for their adventure. Kelly has already landed and is on her way here now, October 9]
It was Whitney’s day to shine as she was not only giving the morning educational lecture on neonatal seizures, but she also seemed to have the bulk of patients for the day as there were many children. If there was a child that one of the others saw, chances are that Whitney had some involvement in the case in some manner. Her lecture was quite helpful, and she used cases to present the topic which always seems to work the best here and has the most participation by the FAME staff which is what we’re really trying to achieve.
There was also good news on our new FAME emergency room that is being built as they began taking down the corrugated sheets of aluminum that had been hiding their progress until now. I believe I had mentioned previously that we have needed a larger, full equipped emergency department here at FAME and were finally able to break ground with the committed funding last year and the pandemic seemingly behind us. We see a great many emergency patients here at FAME, but it should be noted that these patients are routinely brought to in private vehicles, so the initial triage of the patient does not occur in the field as it does in the US and other countries who have the infrastructure to support emergency medical services. Here, there are no emergency services that are provided prior to the assessment that occurs at the hospital. Here in Tanzania, there is no 911 to call, no rescue squad to attend to an accident, or a seizure for that matter. If a patient requires medical care, emergent or otherwise, they are brought to the hospital, and not by any medical personnel.
In addition to the new ED, FAME now also has a fully equipped ambulance, thanks to a gift from several of our board members, that will be able to transport patients the several hours who need more complex care than we can offer here. Patients that come to my mind are the neurosurgical cases that require the expertise of a fully trained specialist and an operating room and nurses outfitted for such cases. With our current surgical staff here, now doing emergency burr holes for acute subdural hematomas is entirely possible, and have been done, so providing care to those patients has been made possible following the visit of Sean Grady and Kerry Vaughn who brought two manual drills for such purposes along with the training of the doctors and nurses on how to do the procedures. These patients are often unable to make the trip to KCMC in Moshi due to the urgency of their condition or to the fact that, even though these are life-threatening conditions, there is still a cost issue at the other end that can be dealt with much more easily here. These are the sad realities of a lack of a national health care system coupled with a lack of a safety net for care such as the EMTALA laws that we have in the US for providing emergency care.
As I mentioned, it was a particularly busy morning of pediatric patients for Whitney and one in particularly was a bit puzzling for us. She had seen a baby with a bulging, and somewhat pulsatile, fontanelle (the opening on the top of a baby’s head that closes as the skull develops usually after the first year of life) that was concerning for the possibility of hydrocephalus. With the child’s age, it was necessary for us to do a CT of the brain, which the child wasn’t the most cooperative with, but we were able to see enough to know that they didn’t have this condition. That was a bit perplexing as it meant that there was something else causing the fontanelle to bulge and raised concern about some vascular anomaly that would require us to give the child IV contrast for the scan. This meant bringing the baby back, which was not a cost issue, but more of a logistical issue as they would need to be sedated and the baby was breastfeeding and will need to hold off eating for several hours per their protocol here at FAME. Somewhat comically, while sitting in the CT scanner to look at the non-contrasted scan immediately after it was finished and recognizing that there was no hydrocephalus, I asked about sedating the child and said, “I wonder if the child has eaten recently,” only to turn around and see mom breastfeeding the child in a chair directly behind me in the CT control room. I promptly replied to my own question, “never mind.”
After the onslaught of children in the morning, it had slowed down enough in the afternoon for us to consider a trip to visit Phillipo, who I have been bringing the residents to over the last several years. We had first visited him on a fluke as we had taken a hike from the brick quarry up to the wood carvers in Tloma Village on the Gibb’s Farm Road. While there, Mbuga, the wood carver asked if we wanted to visit his friend next door who had a small coffee farm. Phillipo and his wife, Fausta, run a small, family coffee farm of approximately five acres, hand picking and processing all the coffee themselves on the grounds of their small home. Not only have a I found their coffee to some of the very best in the area, but they also demonstrate how everything is done and I have never been there when they weren’t roasting their small batches of coffee, ready to package. They have become a required stop for my visiting groups and the friendship has grown as I visit him at least four times a year now. His daughter, Eliza, is also one of my favorites as I always find her so happy and willing to help her parents. They have an older son, whose name I don’t recall at the moment, but I believe he may now be away at school.
The raw coffee berries are put into a special hand processer where the shells are taken off and discarded for composting and used for fertilizer later. The beans are then soaked and placed on drying racks and, when ready, are pounded to break off the outer shells. Then they are winnowed, my favorite as I collect winnowing trays made by the California Indians, which means to separate the chaff from the beans, which are then ready for roasting. Roasting the beans is again done by hand over hot coals for about 45 minutes, constantly rotating the drum containing the beans as they will burn if it stops for any length of time. Once the beans are done, the drum is lifted, very carefully, over to a cooling bin where they sit on top of a screen mesh and then stirred and rocked to allow for an even cooling and to prevent any scorching. Once cool, the beans are ready to be packed into 500-gram plastic bags that are hand sealed with heat by holding the seam against the box used for roasting and containing the hot coals. Incredibly efficient and simple.
As this is a family affair, Fausta works on the treadle sewing machine sewing the colorful cloth bags in which the coffee is placed with Eliza helping in pinch. In addition to selling their coffee and demonstrating how it is made, they also make sure that everyone has had a chance to sample the coffee, serving a small cup of rich, French pressed coffee that is absolutely delicious and, even more, given the fact that the beans were just roasted. Along with his coffee plants, Phillipo also keeps many bee hives distributed around his home where the bees who pollinate the coffee bushes are living and producing honey, another byproduct of the production process. The bees are small, stingless bees and their honey has a remarkable floral taste to it which we also get to sample. Wajiha loved the honey so much that she purchased two small jars of it to bring back home for herself.
It was well after sunset when we were finished at Phillipo’s and the residents were interested in stopping back by the woodcarver’s shop next door as well as Athumani, the painter, who also shares space with the woodcarver. I have purchased several pieces from Athumani in the past as he has a very distinctive style and creates his canvas using scraps of colorful cloth which he then paints on top of and incorporates into his design for the work. Something I had only found out recently about Athumani, is that he has also been extremely active in teaching art to children who are on the street or of lesser means in the hope of giving them not only skills with art and discipline, but also learning how to have dreams and to pursue them. Once I find out such things about a person, they earn a special place in my heart, and it is difficult not to see them in a much different light. Everyone here is in survival mode given the amount of poverty and just how difficult it is to provide for yourself and your family, but when people then go out of their way to provide opportunity for others, it places them on an entirely different level in my mind.
Two of the residents proceeded to purchase paintings from Athumani. They will take these home, have them re-stretched and framed, and then placed on their walls so they will always remember their time here at FAME and in Tanzania, though I don’t think they’ll necessarily need the paintings to remind them. They will always carry this memory with them and refer to it often, as I have done. It is impossible to have spent time here and for it not to have changed you for the better.