Our day began with a surgical lecture on intestinal obstruction given by Judith, who is volunteering here at FAME, but whose last day will be tomorrow as she has taken a job at KCMC. To be honest, I haven’t thought about intestinal obstruction in a long time, though it never hurts to have a refresher on a subject that may come in handy sometime. Morning report began immediately after our lecture and then clinic after that.
Whitney began the day seeing a young 4-year-old boy back in clinic who had a stroke earlier this year based on his history. For some reason, we had seen him last week at Rift Valley Children’s Village even though the child lived in Karatu, and it wasn’t clear exactly why that was given the fact that the Children’s Village was 45 minutes away. Regardless, the child needed to be sent for laboratory tests (which could only be done here at FAME) as part of his work up for stroke, which isn’t the most normal thing for a 4-year-old to have. We sent off a slew of tests, some of which would come back today and others that would not.
Shortly after, Jenna and Fien were seeing a young woman who came in to see us and who was just over two months pregnant, and it was reported that she had developed rather sudden onset of a head shaking tremor. Though she had significant social stressors making it very possible this was a functional movement disorder (FMD), I was just not ready to blow it off completely and when she was asked to suppress the movement, even though it lessened, you could still see some of the muscle contractions. There is a movement disorder that is associated with pregnancy called chorea gravidarum, though luckily it is most often a self-limiting process unless associated with anti-phospholipid antibodies or rheumatic fever. We couldn’t check for the former and she had nothing clinically to indicate the latter. I sent a video off to some of our colleagues who are movement specialists and will wait to hear from them.
Lastly, Fien had a very interesting patient who was HIV positive but had been off and on their anti-retroviral medications over the last two years and was now complaining of right-sided symptoms that were progressive. On examination, she was found to have a mild right hemiparesis and when we looked back at her HIV record from the government clinic (which patients carry with them), we found that her most recent CD4 count, essentially telling us how well her immune system was working, indicated that her count was lower than it should be meaning that she was at risk for opportunistic diseases associated with HIV. With that information, the possibility of her having a neoplasm or an infection in the brain causing her focal symptoms became a significant concern.
We began a discussion with her about the need to obtain a CT scan of the brain, but as is often the case, she did not have the necessary funds to cover even a portion of the cost. Patients are usually asked to at least contribute something towards the cost of the scan, though reported that she was unable even to do that. There was still some hope, though, that she might be able to raise some of the money from her village or family and would pursue that option.
Typically, on our ride home from the Serengeti, we always stop to visit Kitashu in his boma on the crater rim, but unfortunately, we were running so late last Sunday that we were unable to make a real visit out of it. When there’s time, all the residents are taken into the some of the huts and then dressed in traditional Maasai clothing and jewelry after which they participate in dancing and singing with his family. There are many “cultural bomas” throughout the region and in the Ngorongoro Conservation Area where safari companies will bring their guests to see what a Maasai boma is, have an opportunity to dance, and to buy some Maasai beadwork and other crafts. The companies pay the Maasai for these visits and there is no relationship to any of the Maasai in the boma per se.
Visiting Kitashu’s boma is quite different for we are invited to visit and are treated like honored guests by his family. I always bring gifts for his mother or wife that consist of staples such as tea, honey, rice, cooking oil, soap, and other essentials while we are often treated to a traditional goat roast by the boma. Kitashu is always very proud to have us visit his family and when this couldn’t happen last Sunday, it was very disappointing, and I felt bad about letting them down as they often prepare in advance for our visit. We were still able to give the kids their pipi, Swahili for candy, but we didn’t have time for the dancing with his family. As it was, we got to the gate late and could have easily been refused passage which would have meant an unplanned night in the crater which is not as cool as it sounds as it would have meant not only finding a place to spend the night (Kitashu offered for us to go back to his boma and sleep there), but also having to pay for an additional day in the crater. Basically, it would not have been a good thing.
Instead, Kitashu has invited us to his brother’s boma on the other side of Mto wa Mbu in the Lake Manyara area. To be honest, I wasn’t certain what to expect, but on arrival discovered that his brother’s boma was one of the many cultural bomas in the area and that his brother and his extended family, who were only meters off the main road, had guests coming to visit throughout the day. On our arrival, there were several safari vehicles already there and their clients were already participating in the dancing and singing. After being introduced to Kitashu’s family, we were brought into the boma and each of the girls were taken into a separate hut to be dressed. It was clear that they were doing something extra for us as the other guests weren’t dressed nearly so thoroughly or with the jewelry that was placed on them.
Everyone was eventually taken out in front of the boma at which point, the men and women organized and then began to dance. There were other tourists present when they were dancing and having seen this many times before at Kitashu’s boma, it was the same as what everyone had done in the past, except for the fact that we in a hot and dusty place with vehicles zooming by in the very close distance. Regardless, the dancing went on for about 15 minutes or so, often alternating between the men and the women, and, at other times, in unison. After the end of the dancing, we all went back in the boma, and they brought us to a larger hut where all the pre-school age children were going to school.
The girls had bought colored pencils and paper to give to the children, but first they had some songs to sing to show us what they were learning. There was a chalkboard on which their lessons were written, but they could all sing them from their memory. Afterwards, the pencils and gifts were handed out to the children and later, after we had moved on for our tour, I spotted several of the children running around with the paper or with some of the other items that were given to them.
Our last stop was to be a large ring of tables that had been set up to display all the women’s handicrafts and it turned out that Kitasuhu’s mother was living in this boma as living on the crater rim, where she was before, had been too cold for her arthritis. Kind of like moving to Palm Springs or Phoenix, where the weather is far drier and more suitable for elderly patients with health issues. His mother was also incredibly sweet and gave us each a small gift, which for me was a lovely beaded leather keychain, so I immediately turned around and purchased another one from her for Jill.
Though I would have preferred having everyone dancing and singing with Kitashu’s immediately family in his boma in the conservation area, doing that wasn’t possible at this point and visiting here was certainly a good taste of what their dancing is like. The Maasai are a very culturally distinct group living in Tanzania and Kenya predominantly, having traveled here from the north some 200 years ago and who now occupy much of the arid lands of Northern Tanzania. Bomas within the conservation area, though, have much more in the way of good grazing lands for their cattle, of which there are many. Without going into details, I will say that there are huge political factors ongoing at the present time that have to do with the Maasai in the conservation area and concern for overcrowding, many of which remain unresolved. Over the coming years, there are very likely to be many changes and the hope is that in the long run it will be better for all.