It was waking up in a completely new country as well as new continent for Dennis and Caroline, having just arrived in Tanzania yesterday and then traveling the three hours from Kilimanjaro International Airport to our home away from home, Karatu and FAME. Meanwhile, Kelly Boylan, who was attending a wedding in London that was a day later than she had originally thought, would be landing here early this morning, and then making the journey to Karatu to arrive by noontime. It would be Fien’s last week with us as she was overlapping the two groups, which worked out quite nicely as she was able to orient Dennis and Caroline on the electronic medical record last night and she could also attend morning report and make rounds with the ward team this morning since she already knew the routine here. Not that it was intentional, but it could not have been planned any better and I was quite thankful that she was here not only for that reason, but also for many others. She has been a significant part of the team and a huge help during her stay.
Having come here for so long (this is my 28th trip to Tanzania and my 27th visit to FAME over the last 15 years), the sheer beauty of this country is something that I have come to know very well, and though I have never taken it for granted, I have become accustomed to it. It’s difficult for me to imagine now, just how the residents feel when they arrive here for the very first time. The Ngorongoro Highlands where FAME sits is perhaps some of the most spectacularly scenic landscape that one could ever encounter and, when put together with all the other fantastic sights in this country, it makes for possibly one of the most beautiful countries in the world.
With Fien covering morning report and rounds, I had planned for Dennis and Caroline to have a proper orientation to FAME given by Saidi, our amazing volunteer coordinator, which is the normal course of action. As Fien had started their EMR orientation last night, they finished on the fine points with the translators this morning and before I knew it, they were already seeing patients well before our scheduled start time of 11 am. That was fine as it meant that they could have their tour of FAME later after Kelly arrived (though this never really occurred until several days later) and could just begin the day in clinic. There were numerous epilepsy follow up patients coming in to be seen after six months since our last visit and several who had been started on medications three weeks ago and were just coming to check in with us.
Dennis and Caroline were quite excited to have started so early seeing patient and it seemed like the morning had just begun when suddenly Kelly popped into clinic, having taken a private shuttle all the way from the airport. She had arrived early and made it out through immigration and customs quite quickly, so had a very early start. It wasn’t even noontime yet and we would be breaking for lunch quite soon. Though Kelly was totally psyched (for anyone who knows Kelly, that’s not hard to imagine) to begin seeing patients by herself, I wanted her to work with one of the others first so that she could get the hang of the EMR before starting out on her own. Though we had patients to be seen, there was no reason at all that she couldn’t begin seeing patient after lunch.
Meanwhile, while on rounds, Fien was asked to see a consult for a patient that had been having headaches for some time but was also having severe ear pain associated with them. On his examination, his left ear drum and canal did not look normal and he also had decreased hearing on that side. His neurologic examination was otherwise unremarkable. Given the focality of his symptoms and the abnormalities on examination, I agreed with Fien that the patient would require a CT scan of the brain, which was done, and demonstrated loss of aeration of the left mastoid and probably mastoiditis or other process involving the left mastoid bone. This was something that would have to be handled by an ENT specialist and, thankfully, the patient was financially able to go to KCMC, where they have several surgeons who would be capable of treating him.
The decision to transfer patients here is not solely based on medical need, which of course they must meet initially, but also on whether the patient, the family, or their community has the financial means to cover the cost of care at the accepting institution as the vast majority of patients here do not participate in the national healthcare insurance. There is a system that enables children with cancer to receive care for free, but even that can be very costly to the family as it often involves going to a larger medical center for treatment which means that the entire family may have to be uprooted to be close to the facility. There are, unfortunately, no easy answers to this type of dilemma, other than nationalized healthcare, but that is totally dependent on the wealth of the country, and Tanzania is in the bottom tenth in that category. In the end, patients and families much make these difficult decisions every day here, though I am sure there are very many families in the United States making similar decisions due to our lack of a nationalized health care system, or, at the very least, a two-tiered system that we should have had a long time ago (I’ll get off my soapbox now).
As it was the resident’s first day here, it was decided that we would have a quiet evening at home, and they all took the opportunity to get outside and have some fun with the frisbee. Our neighbors Pete and Amanda, along with their two children, Ollie and Astrid, were also out an about and the evening was absolutely gorgeous. Dennis had brought a drone with him and also took the opportunity to fly it around a bit and take photographs of the surrounding area. Its range is amazing, and I was incredibly impressed with the clarity of the photographs. Unfortunately, or perhaps for the better, drones are strictly forbidden in any of the national parks which I suppose is due to the risk to the animals for any harm should a drone come close to them.
Tomorrow morning, Leslie, a family medicine NP who is here volunteering for her second time, will be giving the morning lecture. It will be interesting to hear her take on things as she also speaks Swahili, having spent time here in the Peace Corps in the past where they had spent several months of intensive language training. Despite living in Washington, DC, and not speaking it regularly, she has retained a good amount and is able to speak it conversationally. I am incredibly jealous and also a bit ashamed given the amount of time I’ve spent here and being only able to speak short phrases and responses. I’ve never been good at languages, and it becomes more and more difficult as I age. Oh well.
