Monday, October 16 – It’s off to Mang’ola for the day and a visit to Lake Eyasi…


A morning run for Kelly and Caroline

Though our fun exploring Ngorongoro Crater was now over, and it had been a wonderful day, we were now about to depart for Mang’ola, an even more remote region of Northern Tanzania where the Hadzabe and Datoga tribes live and is quite unique. Mang’ola is a small region at the eastern end of Lake Eyasi, a large saline lake that sits in the Rift Valley and is bordered on the north by the Ngorongoro Conservation Area, but the southern shore of the lake is home to the two dominant tribes in the region. The Datoga are a pastoralist society like the Maasai, while the Hadzabe have remained hunter/gatherers and are considered the bushman of Tanzania. Another unique feature of the Hadzabe is that they speak a click language of which there are only of few peoples on the planet that do and the connection between them remains a mystery.

When I first came to FAME in 2010, there was a large monthly clinic that came to this region in which literally half of the FAME staff would attend in the Eyasi region quite far down the southern shore of the lake. We would take an all-wheel drive vehicle along with several Land Rovers, doctors, nurses, lab techs, social works and support staff to the region and provide medical care to the Datoga and Hadza tribes for an entire week at several sites. It was a true adventure considering there were few roads, and we were often breaking trail to get to where we needed to be. On one occasion, there had a flash rainstorm in the mountains above and a sudden river appeared to completely block our way until we waited an hour for the water to recede after which we successfully crossed with a bit hard labor to knock down the steep embankment.

Caroline and Dorcas ready to work
Hussein and Dennis all prepared
A welcome gift of medical equipment

Each day, well over one hundred patients would line up for medical care that was provided by the staff, while I circulated to see if there were any neurologic issues that I could help with. It was truly an exciting time being on those expeditions and there were always incredible stories to tell when we got back. That clinic ended in 2012 when the grant that funded it ran out, but over the last several years, we have continued to provide a neurology mobile clinic to two of the health dispensaries in villages that are at the eastern end of the lake and closer to Karatu. Barazani, which is the village we would be traveling to today, lies pretty much on the shore of Eyasi and is a small town that even though it’s completely off the beaten path, there are some tourists who make it here, mainly to visit with the Hadza. There are also some lodges here for those travelers planning to spend several days. The other village, Mbuga Nyekundu, would be our destination for tomorrow and is further southwest of Barazani, but still in Mang’ola region.

Christopher’s pharmacy

Barazani is about an hour from Karatu on an incredibly dusty (especially in the dry season) and rocky road that essentially loops around Oldeani Mountain and traverses some amazing and diverse landscapes. The road, which is often washed out in the rainy season by torrential downpours coming down from the hills in very sharp and steep canyons. You can easily see in the washes, that are now dry, how the water has carved steep walls and it’s not difficult to imagine what this must look like when the rains come. I’ve driven this road dozens of times and know it very well, though you must be very vigilant when driving it and it is bumpy and rutty and you must anticipate your path through nearly every section.

A few guests

We bring both vehicles given the number of people coming on mobile clinic. We had four interpreters with us today as Amos has accepted a job at Rift Valley Children’s Village since their volume has increased with the building of their new health center (build it and they will come) and the situation in the conservation area with the reduction in services in that region. Three of the four interpreters were with us in the stretch Land Rover (Turtle) and Nuru was in Myrtle, or the short Land Rover, along with our nurse, social worker, receptionist to register patients, and a driver for the second vehicle.

Driving to the beach

Turtle and Myrtle on the beach

When we arrived, we met with the clinical officer who runs the dispensary before anything else as we were their guests. It’s always customary to say hello and announce our arrival rather than just assume we’re welcome. Each time we come, we greet the person in charge and ask if it is OK for us to set up our portable pharmacy and occupy their exam rooms to evaluate the patients. This is a courtesy that is very important to understand as it is very easy to immediately alienate yourself when you arrive at which point you can expect very little assistance from the staff at the facility. The initial greeting here will set the tone for your entire visit and can make all the difference for what type of assistance you can expect from the local staff.

An ad for Coca-Cola

Thankfully, the clinical officer at Barazani is well-known to me as we’ve been traveling there for several years, and he has also been a consistent fixture there. A year or so ago, I had wanted to do something for the clinic given how graciously they’ve worked with us and with the help of Kitashu, had office furniture built that included several office desks, chairs, and benches for the waiting room. These were all stamped as having been donated by FAME and were welcomed as their other furniture had been pretty worn out over time and they clearly needed additional furnishings. I had wanted to bring them some other things that would improve patient care at the dispensary, so this time brought two glucometers for measuring blood sugar along with lancets and testing strips for supplies. I had also brought for them four automatic blood pressure cuffs. They were tickled to have received the new equipment and I’m certain were going to put it to good use very quickly.

Once we were all there in the clinic, it was time to set up the examination rooms for the residents to work in as well as our “pharmacy” or essentially where Christopher would put the medications to distribute when they were prescribed. Lastly, it was a matter of beginning the patient registrations, but before that, I asked Elibariki to say a little something to the patients who had come in an attempt to triage for neurology as we had little interest in seeing patients with musculoskeletal aches and pains or pure orthopedic patients with knee or shoulder pain. Anne had come with us in the past to do this job, but she is now at home with Baby Denzel, and we needed Elibariki to fill in for her until she returns. Despite this triage, though, there a good number of people who seem to slip through every time. It’s not that we don’t want to help, but we’re not there to provide general medical care, as that is done by the dispensary clinical officer, and the last thing we want to do is to step on any toes.

The residents paired up with our interpreters, who were all clinical officers other than Nuru (she is a pharmacy tech), and they began seeing patients. There were quite a few patients who came to be seen by us and it wasn’t until 2 pm that we finally broke for lunch, with the intention that we’d continue working as long as possible in the afternoon to finish off those who needed to be seen by us. We do have a time limit as far as when we need to leave, though, for leaving much after 4 pm means that we won’t get home until after 5 pm, the typical time for FAME staff to leave for the day. Pushing it back another hour will still get us into Karatu before sunset, but any later than that and we would be driving that road in the dark, which is not very advisable given the poor visibility and the animals that wander onto the road.

Even though we were running a bit later than expected, when we packed up all our supplies and were preparing for the drive home, it turned out that nearly everyone wanted to visit Lake Eyasi as it is very picturesque, and an incredible experience based on the past times we’ve visited. There are families of fisherman that set up tents and essentially live on the shore, bring in the small sardines that live in the salty water there. They use small dories to row far out onto the lake where they set their nets and then row back in. Once on the beach, the fishermen begin hauling in their huge nets, using harnesses made of burlap sacks that they wrap around their bottoms and then attach to the rope that may be half a mile out or more. They slowly walk backwards, playing tug of war with the nets filled with fish, eventually landing the nets on shore where all the fish can be harvested.

There are literally dozens of makeshift tents and shacks on the beach in which the families live, along with their children, many of whom come out to see us and are offered the extra soft drinks that we have left over from our lunch. They are always so inquisitive when they see us which is certainly understandable as they probably see very few non-Africans here given the remoteness of this place. Playing with the children, they will often rub the hair on my arms with their hands and are fascinated by this. The visuals in this very remote place are just incredible – looking across to the other shore are the mountains of the Ngorongoro Conservation Area that is the home to a great many Maasai and where we had driven several weeks ago on our return from the Serengeti.

Watching noon Global Health noon conference from Tanzania

After a good amount of time on the beach with more posed photos being taken than one could possibly imagine, we loaded back into the vehicles and started our trek back to Karatu for the evening. The drive was gorgeous for it was the “golden hour,” that being the perfect time for taking photos, and, even though, we were driving non-stop to beat the sunset, the scenery was stunning along the way with the long shadows and intense colors. We would be waking up tomorrow morning and making nearly the same drive to Mbuga Nyekundu for another day of clinic and more adventures.

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