Having returned from the Serengeti less one vehicle, as we had been forced to leave Turtle behind at camp with the fundi who was busily working to return it to running order, we were now back at FAME for a week of continuing to see neurology patients, many new, but some follow ups that we had instructed to return. We have been tracking data on our patients now since 2015, well over 5000 of them, so have lots of information on the distribution of new vs. return patients, where our patients are coming from in regard to areas within the Karatu district and beyond, tribes, categories of illness, medications that are use, mostly to help us with planning future clinics, though all of this data is invaluable regarding a free-standing specialty clinic in rural Africa. An IRB has been obtained, but unfortunately, our efforts were thwarted, or at least delay, by the onset of the pandemic and the inability for those involved in the program to travel. Stay tuned, though, as we are in the process of resurrecting our original plan to make this data available to those who could most benefit from it – the Tanzanian health system.

Mondays are always the busiest of days at FAME, as most patients tend not to come on weekends, though for some reason, many patients were showing up on Sundays until we instituted an additional fee for visits on Sunday as everyone here needed a day of rest and that was the only way to achieve it. Unfortunately, the effect has now been to overload Mondays, though since everyone is well aware of the situation, the expectation at the OPD (outpatient department) is that it will be a late day. The other situation that has been occurring, though, has to do with the fact that medical services in the NCA have been reduced with the plans for the Maasai move and, even though is not yet a fait accompli, just the anticipation of changes has made an impact.

There so many patients by mid-morning that the FAME staff had begun to bring additional benches for patients to sit on in an area near us that was exposed to the sun so required that they also tie a net shade over the top to protect the patients. It was all a bit of mayhem as it was even hard to get around with all the patients around reception and slopping over into our area. Somehow, though, everyone managed and, even though, we ended up losing Annie to the OPD at the end of the day so she could help out, the number of patients left at 5 pm were remarkably small and I was quite impressed with the efficiency of the clinical staff to get everyone managed. Given the number of patients that were there after lunch, I would have thought everyone would have been there until midnight.

One of the more interesting patients that was seen during the day was a little six-month infant brought in by their patients as they were having abnormal movements for the last month. On examination, the child was unfortunately in focal status epilepticus, meaning the child had essentially been seizing continuously for a month and, the concern in that situation is the focality of the seizures and the possibility of there being an underlying mass or other lesion causing them. The child was given lorazepam in a similar fashion as we had done at Kambi ya Simba with our last infant in status, just to break the seizure, and they were then loaded onto an antiseizure medication, though I can’t recall whether Marissa had started them on levetiracetam or valproic acid.

We had strongly recommended that the child undergo a CT scan, but as is often the case, the family was unable to afford the cost of the study at the moment, though did agree to come back and have it done in several days. The child’s exam was actually quite good despite the focal status, but that was not nearly reassuring enough for us to forgo the imaging study. Hopefully, when the return, the seizures will have been controlled, and they will be able to obtain the CT scan to help determine if the seizures are symptomatic or idiopathic.

Though our clinic was steady, we did not have near the extra volume that the OPD had and were thankful for that as everyone was a bit tired from the trip home from the Serengeti. I had checked on the whereabouts of Turtle earlier in the day and the news was that she had been fixed and was back in running order on her way to Karatu. They had changed the cylinder head at the camp and the mechanic was driving the vehicle back through the Serengeti and the NCA to Karatu and should be arriving in the evening. At around 6:30 pm or so, the mechanic, who speaks very little English, was at hour door along with an askari (security), as they wouldn’t let him drive into FAME without first checking with me. After reassuring the askari that yes, indeed, I did know the mechanic, we communicated as best we could – at one point, I thought I was playing charades with him as I was acting out windshield wipers to make sure that he fixed them (which he had). I was happy to have Turtle back at FAME and, even though it had been a major hassle having to get the other vehicle, it all worked out in the end as it most often does.

Everyone wanted to watch a movie for the night and Jenn had purchased “Anatomy of a Fall,” which had just been up for an academy award for best picture, so it was decided that we would watch that. Evan had perfected his popcorn making techniques the night before, even using butter to make it just like being in the movie theater…. almost, that is. The movie was an incredibly character portrayal of relationships and expectations wrapped around a mysterious death and a murder trial. It was well worth watching.

There was a talk on neonatal sepsis at 7:30 in the morning that I had wanted to attend even though it’s a fair distance from what I do on a daily basis, so it was to bed after the movie and another day of our clinic tomorrow.