It was Fien’s last day in clinic as she would be departing tomorrow morning for home after what has seemed like an amazing three-week experience for her given the fact that she had come with very little knowledge of exactly what to expect, and other than a Zoom communication and some emails, knew very little about those she was about to spend every day with. Equally so, other than having met Fien once on Zoom, I had no way of knowing for certain how she would mix with the other residents or what her work ethic would be, though I can honestly say I was fully confident things would work out for the best given our brief meeting and my knowledge of the residents who would be spending time here. Despite all the research and reassurances that one makes in advance, there is always a leap of faith that must be made in the end, and, in this case, things worked out better than any of us could have hoped for. Fien’s presence over the last three weeks provided a tremendous experience for my residents to work with someone from a completely different training program and to discover, that in the end, they were all on equal footing. Hopefully, this will open the door for similar incredibly successful experiences in the future.
Our morning was a bit disorienting for as we approached the large conference room for morning report, there were others standing outside the room waiting to enter. Apparently, there had been a doctors’ meeting at 7:30 am that was purely administrative and had yet to finish, so the rest of us, including FAME staff, were redirected to the smaller education room in the administration building to hold morning report as best we could without the FAME doctors. Anne had come in the morning as her presence at the doctors’ meeting had been required so that she would work with us now and then head home for the afternoon.
I had Fien round with the inpatient team on the ward since she had been the one most involved with the management for the status patient and could best assess how he was doing in regard to any persistent neurologic deficits. Again, we had already completed a CT scan yesterday due to his persistent altered level of consciousness and concern for a process that had produced his seizures, but the scan had not revealed anything concerning and was unchanged from one that had been obtained a years ago demonstrating only atrophy. When Fien finally returned to the neurology clinic, she reported that the seizure patient had been more alert and, even though he wasn’t following commands, he was attending the examiner and awake. Considering the length of time that he had been seizing yesterday and the number of medications he had received, these were very positive signs indeed.
We have been seeing a greatly increased volume of patients coming in after motor vehicle accidents, or what are referred to here as MTAs, being motor traffic accidents. We have also seen several pedestrian vs. vehicle accidents, mostly someone being knocked over by a motorcycle when they are crossing the street. This is one of the reasons for the higher incidence of epilepsy here in that the head trauma leads to brain injury which leads to a seizure focus and focal onset epilepsy. There was a very lucky patient in the ward today who had come in after being struck by a motorcycle with prolonged loss of consciousness and a fracture of her temporal bone who thankfully did not suffer an underlying epidural or subdural hematoma.
As I have mentioned previously, the FAME surgical staff is now equipped to deal with both epidural and subdural hematomas by placing a burr hole using one of the two manual cranium drills that were brought here over a year ago when Sean Grady and Kerry Vaughn visited FAME specifically for that purpose. Sean had previously taught general surgeons in the lower portion of Alaska how to do these procedures as trying to transfer patients with life-threatening bleeding such as a subdural or epidural hematoma is usually unsuccessful as they often worsen and die in route to the tertiary center. More complicated patients such as those with chronic subdural hematomas that would require a craniotomy flap have to be sent to the neurosurgeon at KCMC, more than 3 hours away.
We had many patients waiting to be seen in the morning and, even though we had planned to work only until 2 pm today so we could make it up to Gibb’s Farm for dinner, it seemed like that wasn’t going to be in the cards for us today. In the end, the gods must have been shining on us for it seemed that everything suddenly cleared just in time for us to have our late lunch and then head back to the house to finish to relax a bit before heading out. This group hadn’t yet been to Gibb’s Farm, so it was essential that we get there early enough, not only to explore the grounds, but also to watch the sunset from there are it has one of the very best views of that around.
Gibb’s Farm is truly in its own league and must be one of the most beautiful places on earth when everything is considered. Once a colonial coffee farm that was totally self-contained with their own dairy, wood shop for making furniture, vegetable garden, village for the workers and health clinic, it has now become a truly remarkable destination resort and home base for visiting many of the parks in the area, especially Ngorongoro Crater, and a launching point for the Serengeti. Having never officially stayed there, I can’t comment from that standpoint, but I have toured their rooms, which are just lovely, and have eaten many a meal in their dining room as well as on their veranda outdoors. Their service, cuisine, and ambiance are really impeccable, and visiting Gibb’s must be one of the highlights of the resident’s stay here in Tanzania. I always make sure that any visiting faculty who have accompanied me to FAME are brought here as it is a bit of luxury, but in a style very much Tanzania, and always memorable.
FAME volunteers are given a discount for the lunches and dinners at Gibb’s Farm, mostly in recognition of the fact that they are here helping the community, but also because many of the volunteers are here on a shoestring budget and having a small break in the cost makes it possible for many to go. Even more than the discount, though, we are always made to feel so incredibly welcome despite the fact we are not actually paying guests at the resort. Being here, doing what we are doing, though, makes everyone a welcome and honored guest of the community which is always a very nice feeling.
The view from the veranda or the lawn in front of it is one of the more spectacular in the region, and coming here at sunset makes it even more gorgeous. Once we arrive and I’ve oriented everyone to their new surroundings, my usual habit is to plop myself down on the veranda and have a Moscow mule, which is somehow made all that more refreshing because I am here at Gibb’s. Today, the others have decided to join themselves on the lawn in front of me taking photos of each other with the magnificent backdrop of the view along with all the incredible vegetation that exists there. The lighting here in the golden hour before sunset is to die for.
The last time I was here several weeks ago, the Tloma Village Choir was performing in the evening, but tonight, it would be an Iraqw cultural group of singers and dancers. I had not seen them before, though a similar group had performed one night while Jill and I were staying at the Ngorongoro Crater Lodge last April. There were two musicians, one with handheld drum and the other with a two-string instrument that was played with a bow much like a violin. There were four women dancing and everyone pitched in with the singing. The group leader was quite funny and a real character while telling stories of Iraqw culture for they are the dominant tribe in the Karatu district and have been in this region for at least 1000 years. Of course, audience participation was mandatory as the leader wouldn’t take no for an answer, and after all the women in our group got to dance, it was my and Dennis’s time to move into formation to dance. It was a real workout trying to keep up with the dancers and I was very happy that the dance ended when it did as I wasn’t sure I was going to be able to finish it.
After the Iraqw group performance was over, there was still enough light for the residents to all walk over to the vegetable gardens, though, as I’ve mentioned before, a blanket of darkness falls very quickly here at the equator and can often catch you off guard. Thankfully, everyone’s phone now has a flashlight, so they were able to make it back to the main lodge without incident. A table had been set up for us outside on the veranda, which was actually perfect for the evening wasn’t too cool or too hot, but just right. There were light throws on each of our chairs if anyone felt they needed it and several of the others put them on after a bit. Dinner was scrumptious, as usual, and we all left that evening quite full and satisfied. My friend, Nish, from the African Galleria, did join us at the end of dinner and purchased several bottles of very nice champaign which was certainly a nice touch to the evening.
We were off tomorrow as it was a holiday here and, given that the clinic had been slow, it was felt that the staff should have the day off. Fien wasn’t leaving until 10 am so there was no rush to bed. Everyone had enjoyed the evening thoroughly.
