We had planned to spend a second day at RVCV and were once again looking forward to the African Massage Road, though we certainly would not be taking the scenic route home this afternoon. Early on, FAME had provided a full medical clinic at RVCV every two weeks for one or two days to prevent having to bring the patients over to FAME, though perhaps four or five years ago, that was discontinued. It had turned out that patients from outside the Oldeani village were traveling to attend the clinic which was not at all the intention, and it would be less expensive and more able to be controlled if the patients were first seen at the RVCV clinic and then, if needed, were referred to FAME for further care. In this manner, they were better able to provide care for people from Oldeani, and that their community was healthier.

Neurology had originally traveled with the mobile clinics to RVCV, though, when they were discontinued, it merely meant that we would go over there on our own and that has been the model ever since. Every six months, we spend two days at RVCV seeing not only India’s children, but also those children and adults from Oldeani who are in need of neurological care. RVCV had always employed a nurse or nurse practitioner from the US to provide care through their local clinic that was very small and had only a few rooms. Patient charts were kept there, and they would contact patients in need of follow up in advance of our arriving to see patients.

Africanus was the first Tanzanian clinician (he is a clinical officer) to be hired for the job at RVCV, and this trend of hiring Tanzanians was also something occurring at FAME. Though we have always had a full Tanzanian staff at FAME in regard to the clinical staff, our volunteer coordinator and social media director positions had always been held by westerners, though several years ago with the hiring of Prosper as the volunteer coordinator and Sue as our social media director, FAME had also moved in the direction of hiring Tanzanians and we haven’t looked back.

Africanus has really done an amazing job with the health center at Rift Valley as it is now a beautiful facility that really leaves nothing to be desired from our standpoint. At most of our mobile clinics, we are scrounging for tables and chairs and places to put them, and not finding them. Here, we had four lovely consultation rooms with enough tables and chairs for everyone, including Marissa and myself in the back where we were staffing patients. Last year and the year prior, I donated tables, chairs, and even benches for the patients, to the clinics at Barazani and Mbuga Nyekundu as trying to find these items always seemed like it took half a day, and we were often unsuccessful. Having furniture to see patients is not an absolute necessity but does make things a bit easier. In the village of Upper Kitete, where we no longer go, we would see patients in the nurse’s office sitting on a stool with the patient on a bed, while in the labor and delivery room, we would just use the two available beds.

In the early days of our mobile clinic, around 2011, Paula and Amir had taken me to make house calls to some patients who were unable to make it to the villages. In those situations, we would see patients wherever it was practical, and it always seemed to work out somehow. Being creative in these situations, or to be honest, in Africa, is a necessity if one is to ever get things done or be successful in ay way. I believe this falls under the heading of “TIA” – This is Africa – which Frank taught me to use on a daily basis when encountering any of these situations.

On arrival to the clinic, following our drive on the African Massage Road, there were already patients waiting for us on the shaded benches out front, though everyone needed to caffeinate a bit first and headed for the kitchen. We had gotten there a few minutes earlier than we had yesterday, so there was no concern about the time. With everyone back at clinic, though, it was time to get down to business and to begin seeing patients. Joe had decided to spend another day relaxing at Gibb’s, and you could certainly not blame him for wanting to do so. We had worked hard last week with many patients and, given that he and his wife, Sandy, were staying at Gibb’s as there was no room at FAME (how sad for them), it was not surprising that he wanted to take advantage of the activities there. Gibb’s Farm is one of, if not the oldest, lodges here in Northern Tanzania and is truly an amazing place.

I don’t think there was anything surprising in clinic for us today, though one of the residents had a patient who had suffered from Pott disease a number of years ago, with significant vertebral collapse, but, thankfully, was not paraplegic as most patients with this condition are. Specifically, Pott disease is tuberculosis of the spine, or tuberculous spondylitis, and causes collapse of the vertebrae and spinal cord compression. The thoracic spine is most commonly involved with the lumbar and cervical levels following. This extrapulmonary manifestation of TB does not present acutely but takes time to develop such that patients will usually present with back pain, often without neurologic manifestations initially. Patients presenting with the complaint of back pain and a history of TB, therefore, must be more fully evaluated out of concern for vertebral osteomyelitis.

Several years ago, just after I had left FAME for the Serengeti, a young patient presented with back pain and lower extremity weakness that had just begun and on examination, was myelopathic. With a few WhatsApp messages, I diagnosed Pott disease and told them to obtain a CT of her thoracic spine based on a lack of upper extremity signs and, indeed, she had erosion of her T5 vertebrae and compression of her spinal cord. She was referred immediately to KCMC for orthopedic surgery due to her compression, though I don’t believe she ended up doing well in the end which was very unfortunate.

For those that know me, it’s not very surprising that I’m going to once again mention the meals at RVCV, but today’s lunch was once again delicious – homemade bread, chicken salad, tuna salad, fruit salad, and a green salad with some incredible cookies for dessert. Once again, our Tanzanian support staff, except for Dr. Anne, had decided to eat something more palatable for them.

Once finished with our clinic, the residents went over to the small duka (store) next door to the clinic to look at handiwork from the Rift Valley Women’s Group to look for things that might interest them. I have purchased lovely items from the shop over the many years that I’ve been coming to RVCV and have given many of the items away as gifts, though some of the original pieces I purchased have remained in my home and remind me of this very special place every time I see them on my shelves.

We were eventually on our way home and there wasn’t any question whatsoever that I would NOT be taking my shortcut through the fields again, which came not only from me, though had I even thought of going there again I think there would have been a mutiny by the rest of the team. Yesterday’s drive was one of the more hairier drives I’ve taken anywhere, and, considering how long I’ve been driving here in East Africa, along with the fact that I used to drive a Forest Service fire truck off road in the High Sierra, that’s saying just a bit.

For the evening, the residents had very much wanted to go to the new Lilac Oasis on the outskirts of town as, even though it wasn’t yet fully open, they had told us they would be happy to have us for dinner some evening. It’s a beautiful new facility that, when it is fully completed, will have a spa and swimming pool, as well as a bar and restaurant. When I first came to Karatu in 2010, Nicky was working as the manager of the Happy Days restaurant, but soon after opened the Lilac Café at FAME, and now has numerous hospitality businesses throughout Karatu including being a partner in the Black Rhino International Academy where Jill is working.

Jill and I had decided to skip the Oasis and let the residents have an evening off from being supervised by me and, instead, since Jill was already visiting with Joe and Sandy at Gibb’s, we decided to have dinner there. After dropping everyone off at the Oasis, I decided to take advantage of the amazing pool at Gibb’s Farm – the water had a chill, but it was perfect for the warm day and incredibly refreshing. The view from the pool is the same as from the veranda and looks out to the west in the direction of FAME. Looking out over the edge of an infinity pool with the mountains and the sky in the distance and the sun beginning to set, it’s just magnificent and there is very little that can match that combination.

Dinner at Gibb’s is also a total experience, and even though we had planned to come back tomorrow night with everyone, it was a lovely affair. Having been working in Karatu for the last 14 years, I have come to know many of the staff at Gibb’s Farm and it is always a reunion returning there. Jill and I arrived home around 9 pm to an otherwise mostly quiet house thinking for sure that the residents were still out at the Oasis. We were up for a bit listening for their return, though never heard it, but figured that they were grown up adults and could care for themselves. As Joe had a 7:30 am lecture in the morning, we were up early, and I was surprised to find Megan up and preparing her breakfast as I had assumed she had come home late and was even further surprised to learn that had all arrive home before us last night and had all gone to bed. Some things never cease to amaze you.